Thrombosis following ovarian hyperstimulation syndrome

Abstract

The aim of this review is to analyse the pathophysiology and complications of thrombosis in conjuction with ovarian hyperstimulation syndrome (OHSS) following ovulation induction and to suggest practical guidelines usefull for the prevention and treatment. Although the incidence of thrombosis varies from 0.2% among in vitro fertilization (IVF) cycles and up to 10% for severe cases of the syndrome, it represents the most dangerous complication of OHSS. Different changes in haemostatic markers have been found to create a state of hypercoagulability, but no single standard test is available to estimate the state of thrombosis. The role of markers for thrombophilia is controversial. Thromboses are mostly venous (67-75%) involving upper limbs and neck, then arterial (25-33%) which are mainly intracerebral. The predominant sites of venous thromboembolism in the upper part of the body may be explained by higher concentrations of estrogens drained through lymphatic ducts from ascites and by compression of rudimentary branchyal cysts. Once early diagnosis is established, it is crucial to use an anticoagulant treatment with heparin proceeded with thromboprophylaxis. However, identification of patients at risk and preventive measures of OHSS are the best means in reducing the risk of thrombosis after ovarian stimulation.

Severe Spontaneous Ovarian Hyperstimulation Syndrome With Cervical insufficiency: A Case Report

“…This can be a result of early clinical management with low molecular weight heparin. So; like previous studies we also suggest that molecular genetic analysis for thrombophilia markers with other serum thrombophilia screens may be considered for patients with OHSS syndrome [13,14,16,18]. Besides this; our case confirmed that effective treatment strategy that includes cabergoline which is dopamine agonist and has a role of antagonizing and blocking VEGF may potentially reduce the severity of OHSS and related complications [19].…”

“…There is also another PAI existing that is called plasminogen activator inhibitor-2 (PAI-2) that is secreted only during pregnancy by the placenta. So associated with the high PAI levels hypofibrinolysis is commonly found in pregnancies with high thrombotic risk [16]. In addition she demonstrated that she was heterozygous for MTHFR 677C>T and MTHFR 1298A>C gene polymorphisms a genotype where hyperhomocystinemia is common [13].…”

A Brief Review of Stroke associated with Assisted Reproductive Technology

“…The incidence of thrombosis varies from 0.2% of all IVF cycles to up to 10% in OHSS [7]. This is a small percentage, but the absolute number of those affected is considerable given the number of women who undergo fertility treatment.…”

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

“…Th e syndrome almost always occurs a few days after receiving human chorionic gonadotropin (hCG) (early OHSS), or later (late OHSS), which depends on the occurrence of endogenous hCG 1 . Although OHSS may occasionally occur spontaneously between eight and twelve weeks of pregnancy or with a follicle-stimulating hormone (FSH) producing pituitary adenoma, the great majority of cases are iatrogenic due to ovulation induction in women undergoing assisted reproductive techniques (ART) 2 . According to the latest European Society of Human Reproduction and Embryology (ESHRE) report, the incidence of OHSS ranges from 0.18% to 1.40% of stimulated in vitro fertilization (IVF) cycles in European countries 3 .…”