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Polycystic ovarian syndrome, metabolic syndrome, and obesity in pregnancy
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be required. Women with PCOS undergoing IVF +/− ICSI need to be counseled on increased risk of ovarian hyperstimulation syndrome (OHSS).
Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Ovarian hyperstimulation syndrome (OHSS) is generally classified according to the severity of symptoms into mild, moderate, severe and critical (1). In mild OHSS the symptoms are of mild abdominal pain and abdominal bloating, and on ultrasound scan (USS) the ovarian size is usually under 8 cm (1). In moderate OHSS the patient complains of moderate abdominal pain and nausea with or without vomiting (1). USS shows evidence of ascites and the ovarian size is between 8 cm and 12 cm (1). Severe OHSS occurs when the patient presents with clinical ascites (occasional hydrothorax) and oliguria and the ovarian size is greater than 12 cm on USS (1). This is associated with a haematocrit of over 45% and hypoproteinaemia (1). OHSS is considered critical when the patient has tense ascites or large hydrothorax with oligo- or anuria and thromboembolism (1). This is associated with a haematocrit of greater than 55% and a white cell count of greater than 25,000 per ml (1). Acute respiratory distress syndrome can occur in this situation (1).
Regulation of Reproduction by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
A major complication of IVF is a risk of multiple births, which is directly related to the practice of implanting multiple embryos. Another risk factor is the development of ovarian hyperstimulation syndrome (OHSS), especially if hCG is used to induce final follicular maturation. In spite of some early reports that IVF was also associated with increased birth defects in infants, these claims were not confirmed in subsequent large epidemiological surveys. See Chapter 7, Section 7.5.2, for additional discussion on OHSS.
Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?
Published in Gynecological Endocrinology, 2023
Nafiye Yilmaz, Pinar Gulsen Coban, Saynur Yilmaz, Hasan Ali Inal, Hakan Timur, Hacer Haltas
Ovarian hyperstimulation syndrome (OHSS) is one of the most severe and life-threatening iatrogenic complications of controlled ovarian hyperstimulation. OHSS is observed at a rate of 0.3% to 5% and can lead to severe morbidities, such as pleural effusion, acute renal insufficiency, and venous thromboembolism [1]. Various vasoactive-angiogenic substances have been implicated in the etiology of OHSS, including vascular endothelial growth factor (VEGF), prostaglandins, cytokines, renin-angiotensin-aldosterone, estradiol, progesterone, kinin-kallikrein, and nitric oxide. VEGF is attributed to be the leading factor in the shift of fluid into the extravascular space due to increased vascular permeability by activating VEGF receptor-2 (VEGFR-2) [2–6]. VEGF also plays a critical role in the stimulation of angiogenesis and endothelial cell mitosis [7–10].
Treatment of women with BRCA mutation
Published in Climacteric, 2023
Since the embryos will not be replaced during the stimulated cycle, a protocol with low risk of ovarian hyperstimulation syndrome (OHSS) can be used. To reduce the risk of OHSS, which can be life threatening, important adjustments to the stimulation protocol can be made [7,8]. Firstly, the gonadotropin dose, needed for the follicular stimulation, should be calculated using the age, body mass index, antral follicle count and anti-Mullerian hormone levels of the patient. Secondly, a gonadotropin/gonadotropin releasing hormone (GnRH) ‘antagonist’ protocol to stimulate follicle growth is to be preferred. As such, a GnRH ‘agonist’ can be used as an ovulatory trigger 36 h prior to the oocyte pick up, avoiding the need for r-hCG. Thirdly, no luteal support needs to be given after the pick-up. Fourthly, in instances where an unexpected high number of oocytes were obtained, further GnRH ‘antagonists’ can be given during the luteal phase. A detailed and extensive description to avoid and to treat OHSS is given in the ACCEPT Guidelines on OHSS prevention and management [8].
Systematic protocol and methodology needed for pre-procedure counselling of elective egg freezing patients in Singapore
Published in Human Fertility, 2023
Alexis Heng Boon Chin, Sherine Sandhu, Lucy Caughey, Mohd Faizal Ahmad, Michelle Peate
There are both medical and non-medical risks associated with egg freezing. Medical risks most commonly involve ovarian hyperstimulation syndrome (OHSS), in which the body overreacts to injected hormones during the process of ovarian stimulation, characterized by severe bloating, shortness of breath and abdominal pain (Pakhomov et al., 2021). Enlarged ovaries due to OHSS may twist (ovarian torsion), and could result in further complications (Pakhomov et al., 2021). The severe form of OHSS can be life-threatening and egg freezing patients may end up hospitalised, but this is extremely rare (Pakhomov et al., 2021). Moreover, day-surgery for egg retrieval is an invasive procedure that carries a small risk of bleeding, viscus perforation and infection (Levi-Setti et al., 2018). In addition to the medical risks per se, prospective patients should also be informed about the various side-effects that they may experience during the egg freezing procedure, such as nausea and vomiting induced by hormone injections, as well as pain caused by daily injections, regular blood tests and ultrasounds.