Is Ovarian Hyperstimulation Syndrome A Serious Condition & Can It Be Reversed?

Ovarian hyperstimulation syndrome happens on the grounds of an abnormal increase in the level of blood plasma sex hormones in women. This adversely affects the functions of the various systems of the body, especially in the ovaries, and characterizes the increase in the size of the ovaries (sometimes up to 20-25 cm in diameter), with the formation of follicular luteal cysts against the background of pronounced stromal edema. The triggering factor of the syndrome is the introduction of the ovulation dose of chorionic gonadotropin.(1)

The base syndrome development is the phenomenon of increased vascular permeability, which leads to a massive leakage of liquid that is rich in proteins, in the interstitial space.

It promotes the development of electrolyte imbalance, hemoconcentration, hydropericardium with or without hypovolemic shock phenomena, hydrothorax, hypoproteinemia, hypovolemia, and increased activity of liver enzymes, oliguria, and the formation of ascites. However, the factor that leads to fluid transduction remains unknown. In severe cases, anasarca, ARDS, arthritis, and thromboembolic complications may occur.

Is Ovarian Hyperstimulation Syndrome A Serious Condition?

Is Ovarian Hyperstimulation Syndrome A Serious Condition?

The description of the above symptoms can be daunting at first glance. It must be mentioned that such symptoms do not appear suddenly and suitable countermeasures can usually be taken at an early stage. At the same time, the likelihood of severe overstimulation is very low at 0.1-2%. The mortality rate is extremely low and rare.

Complications of ovarian hyperstimulation syndrome can occur with the development of thromboembolic complications. The cause of thrombosis in ovarian hyperstimulation syndrome is not known; however, the main role in the pathogenesis of this disorder is withdrawn from high levels of sex hormones, inflammatory cytokines, reducing hemoconcentration and CGO.

Long-term hospitalization, limitation of physical activity, reduced venous reflux due to the increase in ovaries, increased activity of coagulation factors, fibrinolysis, and antiplatelet agents further contribute to the high risk of thrombotic complications in ovarian hyperstimulation syndrome.

The severe course of ovarian hyperstimulation syndrome can be associated with complications that may require surgery. Rupture of the ovarian cyst and intra-abdominal bleeding, torsion of the uterine appendages, ectopic pregnancy are some of the complications that need immediate surgery.(2)(3)

Can Ovarian Hyperstimulation Syndrome Be Reversed?

The therapy of ovarian hyperstimulation syndrome depends on the severity.

Measures That Are Taken At Home (With Mild Forms)

Avoid physical exhaustion, have sufficient hydration (at least 3 to 4 liters per day), cooling of the lower abdomen (this prompts restriction of blood flow to the ovaries), having protein-rich food or protein drinks have also proven to be very helpful.

Symptomatic Relief And Treatment Options To Prevent Complications

The use of infusions (e.g. Multi-Lipid (SMOF) or calcium), boosting kidney function to excrete water, ascites puncture to reduce abdominal pressure, monitoring fluid excretion, abdominal circumference and blood viscosity (the occurrence of very serious complications such as kidney failure or thrombosis should be prevented in this way) Close, outpatient care or inpatient admission (for severe forms)

It can take place in the gynecological department of a hospital or clinic.

How Does An Ovarian Hyperstimulation Syndrome Show Up?

Depending on the severity of hyperstimulation, various symptoms appear. Indications of ovarian hyperstimulation syndrome are – feelings of tension in the lower abdomen, malaise, and slight nausea. This can also occur during normal stimulation and does not require any special therapy.

Moderate Cases

A feeling of flatulence, discomfort, nausea, slight abdominal pain, detection of ascites (water accumulation in the abdomen) and enlarged ovaries by ultrasound

Severe Cases

Diaphragmatic irritation, (upper) abdominal pain, diarrhea, difficulty breathing, nausea, oliguria (changes in urine output), vomiting, ultrasound shows enlarged ovaries and marked ascites (water accumulation in the abdomen), thereby noticeable tension in the abdomen.

Currently, ovarian hyperstimulation syndrome is considered from the point of view of the SIRS, against which there is massive endothelial damage. Patients with ovarian hyperstimulation syndrome in peritoneal transudate have detected high concentrations of interleukins (IL-1, IL-2, IL-6, IL-8), tumor necrosis factor (TNF-alpha), higher prostaglandin synthesis in the ovary, ovarian neovascularization and increased vascular permeability.

Under the action of pro-inflammatory cytokines, systemic activation of coagulation occurs. Size correlates with severe leukocytosis SIRS. Organ system damage caused by severe OHSS is similar to that during injuries or in sepsis.(3)(4)(5)

References:

  1. Sangtani A, Ismail M, Khan Z. Timing of Pregnancy After Ovarian Hyperstimulation Syndrome and Pregnancy-Related Outcomes [35T]. Obstetrics & Gynecology. 2019;133:222S.
  2. Pellicer N, Galliano D, Pellicer A. Ovarian hyperstimulation syndrome. The Ovary: Elsevier; 2019:345-362.
  3. Moderate O. Treatment of Ovarian Hyperstimulation. Complications and Outcomes of Assisted Reproduction. 2017:141.
  4. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thrombosis research. 2017;151:S61-S64.
  5. Dauod L, Schenker JG. Ovarian Hyperstimulation Syndrome (OHSS): Pathogenesis and Prevention. Reproductive Medicine for Clinical Practice: Springer; 2018:83-92.

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