Onm-15: New Approaches in OHSS

Ovarian Hyper stimulation syndrome (OHSS) is one of the most serious and life threatening complication of ovulation induction and is a major concern and challenge for physicians involved in assisted reproductive technologies (ART). The main complication of OHSS is intravascular fluid and protein out flow into third space. Human chronic gonadotropin (hCG) increases vascular permeability by indirect role in production of vascular endothelial growth factor (VEGF). Therefore high level of hCG during pregnancy might lead to OHSS. Furthermore, OHSS can also occur spontaneously due to FSH receptor dysfunction. There have been many different classification systems for OHSS proposed, which generally identify a mild, moderate, and severe subtype with varying internal grades of severity. Cornerstones of OHSS prevention have historically included the following strategies: cycle cancellation with withholding of hCG trigger, coasting, decreasing the dose of hCG trigger, agonist trigger, and cryopreservation of all embryos. Newer techniques include intravenous (IV) albumin at the time of egg retrieval and the use of dopamine agonists. Medical indications for hospitalization include sicker patients who have symptoms that cannot be managed on an outpatient basis. Such situations include severe abdominal pain or peritonitis, severe nausea or emesis, inability to tolerate oral intake, oliguria, pulmonary compromise, hypotension, dizziness, severe electrolyte imbalance, and severe hemoconcentration. In our center, the decision for inpatient hospitalization is made at the doctor’s discretion following clinical evaluation. The main thing that physician should consider is preserving renal and respiratory function by maintaining the intra vascular volume. There is a shortage of large, prospective RCTs reporting OHSS prediction and prevention strategies. Our review showed that risk factors such as antral follicle count and baseline anti-Müllerian hormone level may identify women at high OHSS risk.