Ovarian hyperstimulation syndrome

Abstract

Key content Ovarian hyperstimulation syndrome (OHSS) is characterised by ovarian enlargement, increased vascular permeability and fluid shift. Patients with polycystic ovary syndrome (PCOS) or previous history of OHSS are at increased risk. A reduced risk of OHSS is seen with use of gonadotrophin‐releasing hormone antagonist instead of agonist, coasting of overstimulated cycles, metformin in women with PCOS and dopamine agonists. OHSS is likely to be more severe and prolonged in cycles where conception occurs. Patients of severe OHSS require close monitoring of fluid balance, thromboprophylaxis and attention to effusions. Learning objectives To identify patients and cycles at high risk of OHSS and apply preventative measures. To assess and classify the severity of OHSS. To manage cases of severe OHSS. Ethical issues How do we counsel patients about the risk of an uncommon serious complication of fertility treatment in the face of an overwhelming desire to have a family? Should the risk of OHSS be considered a reason to restrict funding for assisted conception treatment?