I-43: Imaging Findings of PCOS and Prediction of OHSS

Story of collar string of beads, multiple immature follicle, and adverse effect in infertile patients is a concern which can be of child bearing conflict. PCOS is the most common endocrine disorder in women of the reproductive age group. The new definition required the presence of two from the following three criteria: 1. oligo and or anovulation, 2. clinical and or biochemical hyperandrogenism and 3. poly cystic ovaries. According to the available literature,the Rotterdom criteria should have at least one of the followings: 12 or more immature follicles 2-9 mm in diameter and increased ovarian volume>10 cc. By using sonography we can predict one of the most serious complications of infertility treatment: OHSS and with appropriate management we can prevent complication at three levels as described in the following.In the baseline sonography when the clinician is made aware of PCOD pattern of ovaries with changing stimulation management we can prevent OHSS. After stimulation when we see honey combing pattern>15 follicle with10-15 mm diameter in ovaries we alarm the clinician to be more cautious. Finally when OHSS occurs imaging modalities can prevent catastrophic complication such as CRF, DIC, hypovolemic shock and ARDS. Recent assessment of Doppler study may have some value in predicting the risk of OHSS but further study may be needed for confirmation.