Ovarian Hyperstimulation Syndrome

The challenge of taking a baby home without impairing women’s health and quality of life remains the main outcome of reproductive techniques. It is the cost of our attempts to disrupt nature’s precise equilibrium designed to ensure single oocyte ovulation is OHSS. Prevention of this syndrome is intrinsically more desirable than treatment. OHSS is characterized by an exaggerated response to fertility drugs with stimulation of ovarian granulosa cells in gonadotropin-stimulated ovaries leading to swollen and painful ovaries, fluid accumulation in the abdomen, and in severe cases, potential complications such as kidney failure, blood clots, or even death. The primary risk factor for OHSS is the use of high doses of gonadotropin hormones to stimulate the ovaries leading to the development of OHSS, consecutively there are also secondary risk factors that can increase the likelihood of developing OHSS. Early diagnosis and treatment significantly reduce mortality and multi-organ dysfunction. A cascade of pathophysiological events brought on by ovarian overproduction of vasoactive mediators results in increased vascular permeability and clinical symptoms of life-threatening OHSS. With an understanding of the disease and careful attention to fluid and electrolyte management, respiratory support, infection control, and thromboembolism prophylaxis OHSS can effectively manage and protect the threatened lives of critically ill patients. Recognizing high-risk individuals prior to treatment, choosing treatments that respect safety, managing infertility, and performing ovarian stimulation during therapy are primary preventative principles. Few specific preventive strategies regarding the length of infertility, treatment timelines, and the development of minimal risk management procedures with consideration for alternative infertility treatments like insulin resistance drugs, ovarian drilling, and natural cycle in vitro fertilization should be considered.