August 18, 2010

Ovarian Hyperstimulation Syndrome

Ultrasound images show enlarged ovaries with multiple cysts in a woman who had received assisted reproduction procedure. Ascites is also present but not shown on these images.

Facts: Ovarian Hyperstimulation Syndrome (OHSS)
  • Complication related to exogenous administration of human chorionic gonadotropin (HCG) for assisted reproduction
  • Believed to be due to increased capillary permeability, resulting in fluid shift from intravascular to extravascular compartments
  • Broad clinical spectrum, ranging from mild, moderate to severe, but can be life threatening
  • Common in mid- to late-luteal phase
  • Early signs: abdominal heaviness, tension and pain (due to bilateral ovarian enlargement with multiple cysts)
  • Risk factors: young patient (less than 30 years old), underlying polycystic ovaries, high number of follicles and estradiol levels at the time of HCG injection, protocols that utilize GnRH
  • Golan classification describes 5 grades of OHSS based on ovarian size, symptoms (abdominal distention, nausea, vomiting, dyspnea), signs (ascites, pleural effusion, hemoconcentration, hypovolemia, oliguria).
  • Ultrasound most appropriate imaging to confirm clinical suspicion
  • Enlarged ovaries with several cysts
  • Ascites, pleural effusion
  • Necklace sign (string of ovarian follicles close to the surface of the ovary) may indicate an increased risk of developing this syndrome
1. Gianaroli L, Ferraretti AP, Fiorentino A. The ovarian hyperstimulation syndrome. Reproductive Med Rev 1996;5:169-184.
2. Golan A, Ron-El R, Herman A, et al. Ovarian hyperstimulation syndrome: an update review. Obstet Gyncol Surv 1989;44:430-440.

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