Alternative strategies for the management of ovarian hyperstimulation syndrome, the role of intra-abdominal hypertension control

Petrenko, Aleksei; Castelo-Branco, Camil; Marshalov, D.V.; Салов, И. А.; Kuligin, A.V.; Shifman, E.М.; Chauke, Shane Shitsundzuxo

doi:10.1080/09513590.2019.1683822

Cited by 3 publications

(2 citation statements)

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“…Several studies described the management of OHSS in pregnancy [ 54 , 55 ]. In this case, the treatment of OHSS is conservative and should be defined according to the severity of clinical signs, blood clinical parameters and radiological examinations [ 56 ]. The main medical and surgical treatment were extensively described previously [ 54 , 55 , 57 – 60 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases

et al. 2023

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Background Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian hyperstimulation (COH). It is a potentially life-threatening condition that usually occurs either after human chorionic gonadotropins (hCG) administration in susceptible patients or as a result of an implanting pregnancy, regardless of whether it was achieved by natural conception or infertility treatments. Despite many years of clinical experience regarding the adoption of preventive measures and the identification of patients at high risk, the pathophysiology of OHSS is poorly understood and no reliable predictive risk factors have been identified. Cases presentation We report about two unexpected cases of OHSS following infertility treatments, occurring after freeze-all strategy with embryo cryopreservation approaches. The first case developed spontaneous OHSS (sOHSS), despite efforts to prevent its manifestation by a segmentation approach, including frozen embryo replacement cycle. The second case developed a late form of iatrogenic OHSS (iOHSS), even though the absence of any risk factors. No mutations in the follicle-stimulating hormone (FSH) receptor (FSHR)-encoding gene were detected, suggesting that the high levels of hCG due to the twin implanting pregnancies could be the only triggering factor of OHSS outbreak. Conclusion Freeze-all strategy with embryo cryopreservation cannot entirely prevent the development of OHSS, which may occur in its spontaneous form independently from the FSHR genotype. Although OHSS remains a rare event, all infertile patients requiring ovulation induction or controlled ovarian stimulation (COS) may be at potential risk of OHSS, either in the presence or in the absence of risk factors. We suggest closely monitoring cases of pregnancy following infertility treatments in order to provide early diagnosis and adopt the conservative management.

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Section: Discussionmentioning

confidence: 99%

Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases

et al. 2023

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“…Whereas OHSS is a dynamic condition, a rapid increase in volume and/or pressure exceeds Cab, because there is no time for tissue adaptation and moderate OHSS can progress to severe OHSS within a few hours [ 6 ]. Many authors confirm that in such cases, paracentesis is the single most important treatment modality for life-threatening OHSS which isn’t controlled by medical therapy [ 23 – 26 ]. Having the absence of the ability to measure IAP and Cab, the dynamics of the APD/TS ratio can be a surrogate indicator of the IAH degree, IAV increase, reserve capabilities of the abdominal wall’s extensibility and can help in establishing indications for timely performed paracentesis.…”

Section: Discussionmentioning

confidence: 99%

Are anthropometric data a tool for determining the severity of OHSS? Yes, it could be!

et al. 2022

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Background All management guidelines of ovarian hyperstimulation syndrome (OHSS) recommend daily monitoring of women's body weight, waist circumference and note that as indicators increase, the severity OHSS also increases. However, the dynamics of abdominal size and its relationship with markers of OHSS severity have not been highlighted. The purpose of this study is to assess the usefulness of various anthropometric indicators for determining the degree of OHSS severity as well as paracentesis indications. Methods Observational study including 76 women complaining with OHSS. Clinical history, physical examination, laboratory tests, and ultrasound measurement of the ovarian volume (OV) and ascites index (AsI) were done in all cases. Intra-abdominal pressure (IAP) was assessed using an intravesical manometer. The anteroposterior diameter of the abdomen (APD) and transverse diameter of the abdomen (TS) were measured with a pelvimeter. The APD/TS ratio was calculated. Results The APD/TS ratio increased progressively and tended to be the highest in the most symptomatic stage of OHSS (Kruskal–Wallis test, p < 0.001). The median APD/TS was significantly lower in patients with mild OHSS (0.55 [IQR, 0.44–0.64]) compared with severe OHSS (0.87 [IQR, 0.80–0.93]; p < 0.001) or critical OHSS (1.04 [IQR, 1.04–1.13]; p < 0.001). Similarly, the median APD/TS of the moderate OHSS group (0.65 [IQR, 0.61–0.70]) was significantly lower than that of the severe (p < 0.001) and critical OHSS group (p = 0.001). There was a strong positive correlation between APD/TS and IAP (Spearman’s r = 0.886, p < 0.01). The APD/TS ratio showed a significant positive correlation with AsI (Spearman’s r = 0.695, p < 0.01) and OV (Spearman’s r = 0.622, p < 0.01). No significant differences were observed in age, height, weight, body mass index, hip circumference or waist circumference between moderate, severe and critical OHSS groups. Conclusions The APD/TS ratio is related to the severity of OHSS. Monitoring APD/TS dynamics could be a method of indirectly controlling intra-abdominal volume, compliance of the abdominal wall and IAP. In conjunction with clinical and laboratory data, APD/TS might be an indicator for paracentesis.

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Assessing the Usefulness of Severity Markers in Women with Ovarian Hyperstimulation Syndrome

et al. 2020

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Alternative strategies for the management of ovarian hyperstimulation syndrome, the role of intra-abdominal hypertension control

Cited by 3 publications

References 34 publications

Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases

Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases

Are anthropometric data a tool for determining the severity of OHSS? Yes, it could be!

Assessing the Usefulness of Severity Markers in Women with Ovarian Hyperstimulation Syndrome

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