Ovarian Hyperstimulation Syndrome Management and Prevention

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of controlled ovarian stimulation during assisted reproduction. It is characterised by ovarian enlargement, increased vascular permeability and fluid shift into third spaces. Primary prevention strategies centre on individualised stimulation protocols that take account of patient risk factors such as age, body mass index, polycystic ovarian morphology and anti-Müllerian hormone levels. Modifications include the use of gonadotrophin-releasing hormone (GnRH) antagonist protocols, lower starting doses of gonadotrophins, “step-up” regimens and metformin pre-treatment in risk groups. Secondary prevention measures, instituted once excessive response is recognised, range from cycle coasting and adjustment of the ovulation trigger to elective embryo cryopreservation (“freeze-all” strategy) and administration of dopamine agonists to reduce vascular endothelial growth factor activity. Advances in adjunctive treatments, such as luteal-phase GnRH antagonist administration or kisspeptin triggering, offer further outpatient management options. Together these approaches have markedly reduced the incidence and severity of OHSS, but ongoing research seeks to refine prediction algorithms, identify new biomarkers and optimise personalised protocols for maximal safety without compromising pregnancy outcomes.

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Ovarian Hyperstimulation Syndrome Management and Prevention publication trend

The graph below shows the total number of articles in ovarian hyperstimulation syndrome management and prevention across all publications each year (not limited to Nature Index journals).

Technical terms

Ovarian hyperstimulation syndrome (OHSS): An iatrogenic complication of controlled ovarian stimulation characterised by ovarian enlargement, fluid shifts and potential organ dysfunction.

Gonadotrophin-releasing hormone (GnRH) antagonist: A class of drugs used to prevent premature luteinising hormone surge during ovarian stimulation, reducing OHSS risk.

GnRH agonist triggering: Use of a GnRH agonist to induce final oocyte maturation in place of human chorionic gonadotrophin, lowering OHSS incidence.

Embryo cryopreservation: Elective freezing of embryos to avoid fresh transfer in high-risk cycles, preventing exacerbation of OHSS.

Vascular endothelial growth factor (VEGF): A signalling protein that increases vascular permeability and is implicated in the pathophysiology of OHSS.

References

1. Beyond the Umbrella: A Systematic Review of the Interventions for the Prevention of and Reduction in the Incidence and Severity of Ovarian Hyperstimulation Syndrome in Patients Who Undergo In Vitro Fertilization Treatments. International Journal of Molecular Sciences (2023).
2. Interventions to prevent or reduce the incidence and severity of ovarian hyperstimulation syndrome: a systematic umbrella review of the best clinical evidence. Reproductive Biology and Endocrinology (2023).
3. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reproductive Biology and Endocrinology (2012).
4. Metformin decreases the incidence of ovarian hyperstimulation syndrome: an experimental study. Journal of Ovarian Research (2013).
5. Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study. Reproductive Biology and Endocrinology (2012).
6. Dopamine agonist inhibits vascular endothelial growth factor protein production and secretion in granulosa cells. Reproductive Biology and Endocrinology (2015).