Hyperstimulation Syndrome of the Ovary: A review on clinical feature, pathophysiology, risk factors, and prevention.

Authors

Keywords:

controlled ovaran hyper-stimulation, ovarian hyperstimulation syndrome, in vitro fertilization.

Abstract

Hyperstimulation syndrome of the ovary is a dangerous complication of ovulation induction during infertility treatment by gonadotropins stimulation and human chorionic gonadotropin injection. Increased capillary permeability, causing fluid leakage from the intravascular compartment, with the accumulation of fluid in the third-space and consequent intravascular dehydration, is the main change in the pathophysiology of Hyperstimulation syndrome of the ovary. Vascular endothelial growth factor (VEGF) is the main mediator in the development of Hyperstimulation syndrome of the ovary. The recent application of new modalities: GnRH antagonist protocol, GnRH agonist (GnRHa) triggering of ovulation and embryo/oocyte vitrification, facilitates the elimination of Hyperstimulation syndrome of the ovary associated with controlled control ovarian hyperstimulation(COH) for IVF program. In this manuscript, we reviewed the pathophysiology, clinical features, predisposing factors, and both primary and secondary arrangement for preventing Hyperstimulation syndrome of the ovary as there is no single measure to prevent OHSS totally. Therefore, categorizing the women based on their risk potentiality seems to be beneficial to direct the line of management as early as possible to avoid the emergence of Hyperstimulation syndrome of the ovary.

Author Biographies

Rihab Abbas Ali, university of kerbala college of medicine

Department of anatomy, histology and embryology

Maher Abbood Mukheef, university of kerbala college of medicine

Department of biochemisrty 

Hind Hadi Majeed

Department of human anatomy

References

Practice Committee of the American Society for Reproductive Medicine. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility. 2016 Dec 1;106(7):1634-47.

Smith V, Osianlis T, Vollenhoven B. Prevention of ovarian hyperstimulation syndrome: a review. Obstetrics and gynecology international. 2015 May 14;2015.

Iorio GG, Rovetto MY, Conforti A, Carbone L, Vallone R, Di Girolamo R, La Marca A, Alviggi C. Severe ovarian hyperstimulation syndrome in breast cancer woman under letrozole triggered with GnRH agonist: a case report and review of the literature. Frontiers in Reproductive Health. 2021 ;3:37.

Tan BK, Mathur R. Management of ovarian hyperstimulation syndrome. Produced on behalf of the BFS policy and practice committee. Human Fertility. 2013 Sep 1;16(3):151-9.

Di Carlo C, Savoia F, Ferrara C, Tommaselli GA, Bifulco G, Nappi C. Case report: a most peculiar family with spontaneous, recurrent ovarian hyperstimulation syndrome. Gynecological Endocrinology. 2012 Aug 1;28(8):649-51.

Humaidan P, Nelson SM, Devroey P, Coddington CC, Schwartz LB, Gordon K, Frattarelli JL, Tarlatzis BC, Fatemi HM, Lutjen P, Stegmann BJ. Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Human Reproduction. 2016 Sep 1;31(9):1997-2004.

Naredi N, Talwar P, Sandeep K. VEGF antagonist for the prevention of ovarian hyperstimulation syndrome: current status. Medical Journal Armed Forces India. 2014 Jan 1;70(1):58-63.

Jahromi BN, Parsanezhad ME, Shomali Z, Bakhshai P, Alborzi M, Vaziri NM, Anvar Z. Ovarian hyperstimulation syndrome: a narrative review of its pathophysiology, risk factors, prevention, classification, and management. Iranian journal of medical sciences. 2018 May;43(3):248.

Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Human reproduction update. 2003 May 1;9(3):275-89.

Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertility and sterility. 2000 May 1;73(5):901-7.

Kasum M. New insights in mechanisms for development of ovarian hyperstimulation syndrome. Collegium antropologicum. 2010 Oct 1;34(3):1139-43.

Herr D, Bekes I, Wulff C. Local renin-angiotensin system in the reproductive system. Frontiers in endocrinology. 2013 Oct 18;4:150.

Schwentner L, Wöckel A, Herr D, Wulff C. Is there a role of the local tissue RAS in the regulation of physiologic and pathophysiologic conditions in the reproductive tract?. Journal of the Renin-Angiotensin-Aldosterone System. 2011 Dec;12(4):385-93.

Whelan III JG, Vlahos NF. The ovarian hyperstimulation syndrome. Fertility and sterility. 2000 May 1;73(5):883-96.

Practice Committee of the American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertility and sterility. 2008 Nov 1;90(5):S188-93.

Forman RG, Frydman R, Egan D, Ross C, Barlow DH. Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: a European series and a proposal for prevention. Fertility and sterility. 1990 Mar 1;53(3):502-9.

Zosmer A, Katz Z, Lancet M, Konichezky S, Schwartz-Shoham Z. Adult respiratory distress syndrome complicating ovarian hyperstimulation syndrome. Fertility and sterility. 1987 Mar 1;47(3):524-6.

Lamazou F, Legouez A, Letouzey V, Grynberg M, Deffieux X, Trichot C, Fernandez H, Frydman R. Ovarian hyperstimulation syndrome: pathophysiology, risk factors, prevention, diagnosis and treatment. Journal de gynecologie, obstetrique et biologie de la reproduction. 2011 Aug 10;40(7):593-611.

Howles CM, Alam V, Tredway D, Homburg R, Warne DW. Factors related to successful ovulation induction in patients with WHO group II anovulatory infertility. Reproductive biomedicine online. 2010 Feb 1;20(2):182-90.

Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Macedo CR. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2020(12).

El-Faissal Y. Approaches to complete prevention of OHSS. Middle East Fertility Society Journal. 2014 Mar 1;19(1):13-5.

Palomba S, Falbo A, La Sala GB. Effects of metformin in women with polycystic ovary syndrome treated with gonadotrophins for in vitro fertilisation and intracytoplasmic sperm injection cycles: a systematic review and meta‐analysis of randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology. 2013 Feb;120(3):267-76.

Lee VC, Ledger W. Aromatase inhibitors for ovulation induction and ovarian stimulation. Clinical endocrinology. 2011 May;74(5):537-46.

Franik S, Kremer JA, Nelen WL, Farquhar C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2014(2).

Bosch E, Ezcurra D. Individualised controlled ovarian stimulation (iCOS): maximising success rates for assisted reproductive technology patients. Reproductive Biology and Endocrinology. 2011 Dec;9(1):1-9.

Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology. 2004 Oct 1;18(5):773-88.

Castillo JC, Humaidan P, Bernabéu R. Pharmaceutical options for triggering of final oocyte maturation in ART. BioMed research international. 2014 Oct;2014.

Chen X, Chen SL, He YX, Ye DS. Minimum dose of hCG to trigger final oocyte maturation and prevent OHSS in a long GnRHa protocol. Journal of Huazhong University of Science and Technology [Medical Sciences]. 2013 Feb 1;33(1):133-6.

Kashyap S, Parker K, Cedars MI, Rosenwaks Z. Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose. InSeminars in reproductive medicine 2010 Nov (Vol. 28, No. 06, pp. 475-485). © Thieme Medical Publishers.

Kol S, Humaidan P. GnRH agonist triggering: recent developments. Reproductive BioMedicine Online. 2013 Mar 1;26(3):226-30.

Griesinger G, Diedrich K, Devroey P, Kolibianakis EM. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Human Reproduction Update. 2006 Mar;12(2):159-68.

Youssef MA, Abou‐Setta AM, Lam WS. Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles. Cochrane Database of Systematic Reviews. 2016(4).

Papanikolaou EG, Verpoest W, Fatemi H, Tarlatzis B, Devroey P, Tournaye H. A novel method of luteal supplementation with recombinant luteinizing hormone when a gonadotropin-releasing hormone agonist is used instead of human chorionic gonadotropin for ovulation triggering: a randomized prospective proof of concept study. Fertility and sterility. 2011 Mar 1;95(3):1174-7.

Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reproductive biomedicine online. 2007 Jan 1;14(5):640-9.

Xing W, Lin H, Li Y, Yang D, Wang W, Zhang Q. Is the GnRH antagonist protocol effective at preventing OHSS for potentially high responders undergoing IVF/ICSI?. PloS one. 2015 Oct 15;10(10):e0140286.

Delvigne A, Rozenberg S. A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients. Human reproduction update. 2002 May 1;8(3):291-6.

Griesinger G. Ovarian hyperstimulation syndrome prevention strategies: use of gonadotropin-releasing hormone antagonists. InSeminars in reproductive medicine 2010 Nov (Vol. 28, No. 06, pp. 493-499). © Thieme Medical Publishers.

D'Angelo A, Amso NN, Hassan R. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database of Systematic Reviews. 2017(5).

Devroey P, Polyzos NP, Blockeel C. An OHSS-Free Clinic by segmentation of IVF treatment. Human reproduction. 2011 Oct 1;26(10):2593-7.

D'Angelo A. Ovarian hyperstimulation syndrome prevention strategies: cryopreservation of all embryos. InSeminars in reproductive medicine 2010 Nov (Vol. 28, No. 06, pp. 513-518). © Thieme Medical Publishers.

Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Annals of the New York Academy of Sciences. 2006 Dec;1092(1):247-64.

Friedman CI, Schmidt GE, Chang FE, Kim MH. Severe ovarian hyperstimulation following follicular aspiration. American journal of obstetrics and gynecology. 1984;150(4):436-7.

Kummer NE, Feinn RS, Griffin DW, Nulsen JC, Benadiva CA, Engmann LL. Predicting successful induction of oocyte maturation after gonadotropin-releasing hormone agonist (GnRHa) trigger. Human Reproduction. 2013 Jan 1;28(1):152-9.

Ghahiri A, Mogharehabed N, Movahedi M, Hosseini N. Evaluation of intravenous hydroxylethyl starch, intravenous albumin 20%, and oral cabergoline for prevention of ovarian hyperstimulation syndrome in patients undergoing ovulation induction. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2015 Jul;20(7):692.

Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis. Fertility and sterility. 2011 Jan 1;95(1):188-96.

Tehraninejad ES, Hafezi M, Arabipoor A, Aziminekoo E, Chehrazi M, Bahmanabadi A. Comparison of cabergoline and intravenous albumin in the prevention of ovarian hyperstimulation syndrome: a randomized clinical trial. Journal of assisted reproduction and genetics. 2012 Mar;29(3):259-64.

Jee BC, Suh CS, Kim YB, Kim SH, Choi YM, Kim JG, Moon SY. Administration of intravenous albumin around the time of oocyte retrieval reduces pregnancy rate without preventing ovarian hyperstimulation syndrome: a systematic review and meta-analysis. Gynecologic and obstetric investigation. 2010;70(1):47-54.

Naredi N, Karunakaran S. Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome. Journal of human reproductive sciences. 2013 Oct;6(4):248.

Álvarez C, Martí-Bonmatí L, Novella-Maestre E, Sanz R, Gómez R, Fernandez-Sanchez M, Simon C, Pellicer A. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. The Journal of Clinical Endocrinology & Metabolism. 2007 Aug 1;92(8):2931-7.

Garcia-Velasco JA. How to avoid ovarian hyperstimulation syndrome: a new indication for dopamine agonists. Reproductive biomedicine online. 2009 Jan 1;18:S71-5.

Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database of Systematic Reviews. 2012(2).

Kasum M, Vrčić H, Stanić P, Ježek D, Orešković S, Beketić-Orešković L, Pekez M. Dopamine agonists in prevention of ovarian hyperstimulation syndrome. Gynecological Endocrinology. 2014 Dec 1;30(12):845-9.

Várnagy Á, Bódis J, Mánfai Z, Wilhelm F, Busznyák C, Koppán M. Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome. Fertility and sterility. 2010 May 1;93(7):2281-4.

Roque M, Lattes K, Serra S, Sola I, Geber S, Carreras R, Checa MA. Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis. Fertility and sterility. 2013 Jan 1;99(1):156-62.

Lim KS, Chae SJ, Choo CW, Ku YH, Lee HJ, Hur CY, Lim JH, Lee WD. In vitro maturation: Clinical applications. Clinical and experimental reproductive medicine. 2013 Dec;40(4):143.

Downloads

Published

2021-12-29 — Updated on 2022-06-15

Versions

How to Cite

Abbas Ali, R., Abbood Mukheef, M. ., & Hadi Majeed, H. (2022). Hyperstimulation Syndrome of the Ovary: A review on clinical feature, pathophysiology, risk factors, and prevention . Karbala Journal of Medicine, 14(2), 2513–2520. Retrieved from https://journals.uokerbala.edu.iq/index.php/kj/article/view/884 (Original work published December 29, 2021)