Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome
Classification and external resources
Specialty	urology
ICD-10	N98.1
ICD-9-CM	xxx
DiseasesDB	32038
MedlinePlus	007294
Patient UK	Ovarian hyperstimulation syndrome
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Ovarian hyperstimulation syndrome (OHSS) is a medical condition affecting the ovaries of some women who take fertility medication to stimulate egg growth. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.

OHSS is divided into the categories mild, moderate, severe, and critical. In mild forms of OHSS the ovaries are enlarged (5–12 cm) and there may be additional accumulation of ascites with mild abdominal distension, abdominal pain, nausea, and diarrhea. In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. Early OHSS develops before pregnancy testing and late OHSS is seen in early pregnancy.

Criteria for severe OHSS include enlarged ovary, ascites, hematocrit > 45%, WBC > 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance > 50 ml/min, liver dysfunction, and anasarca. Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit > 55%, WBC > 25,000, oligoanuria, creatinine > 1.6 mg/dl, creatinine clearance < 50 ml/min, renal failure, thromboembolic phenomena, and ARDS.

Vaginal ultrasonography in the sagittal plane in a woman with mild OHSS, showing a 33 mm wide anechogenic area behind the uterus in the recto-uterine pouch, which means there was ascites, that is, free fluid in the peritoneal cavity. Normally, there is up to 5 ml of fluid in the recto-uterine pouch, corresponding approximately to an area up to 10 mm wide. The ovary measured up to 6.5 cm in diameter.

Ovarian hyperstimulation syndrome is particularly associated with injection of a hormone called human chorionic gonadotropin (hCG) which is used for inducing final oocyte maturation and/or triggering oocyte release. The risk is further increased by multiple doses of hCG after ovulation and if the procedure results in pregnancy.

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