Navigating the complexities of pregnancy with ovarian hyperstimulation syndrome: an in-depth narrative exploration

Authors

  • Ipsita Mohapatra Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India https://orcid.org/0000-0002-1019-5572
  • Subha Ranjan Department of Obstetrics and Gynaecology, IMS and SUM Hospital-II, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20242528

Keywords:

Ovarian hyperstimulation syndrome, Assisted reproductive technology, Vascular endothelial growth factor, Human chorionic gonadotropin, Pleural effusion, Ascitis

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a potentially severe complication of assisted reproductive technology (ART) procedures, particularly in vitro fertilization (IVF) treatments. While OHSS typically occurs during the stimulation phase of ART, it can also manifest during pregnancy, posing significant challenges to maternal and fetal health. This comprehensive narrative review tries to provide a detailed description of pregnancy with OHSS, encompassing its epidemiology, pathophysiology, clinical manifestations, risk factors, diagnosis, management strategies, and pregnancy outcomes. Relevant literature was identified through a systematic search of electronic databases, with more focus on recent studies and guidelines. Insights from clinical experience and expert opinions are also integrated into the discussion. This review highlights the importance of early recognition, risk stratification, and multidisciplinary management in optimizing outcomes for women with pregnancy-associated OHSS. Areas requiring further research and strategies for prevention and management are also discussed.

Metrics

Metrics Loading ...

References

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

Raju GA, Chavan R, Deenadayal M, Gunasheela D, Gutgutia R, Haripriya G, et al. Luteinizing hormone and follicle stimulating hormone synergy: A review of role in controlled ovarian hyper-stimulation. J Hum Reprod Sci. 2013;6(4):227-34.

Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, et al. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women with Polycystic Ovary Syndrome Undergoing IVF/ICSI. Front Endocrinol (Lausanne). 2021;11:615957.

Kumar P, Sait SF, Sharma A, Kumar M. Ovarian hyperstimulation syndrome. J Hum Reprod Sci. 2011;4(2):70-5.

Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, et al. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril. 2006;85(1):112-20.

Alhilali MJ, Parham A, Attaranzadeh A, Amirian M, Azizzadeh M. Polycystic Ovary Syndrome Develops the Complications of Assisted Reproductive Technologies. Arch Razi Inst. 2022;77(4):1459-64.

Lodh M, Mukhopadhyay J, Sharma V. A case of severe ovarian hyperstimulation syndrome. Indian J Clin Biochem. 2014;29(3):386-9.

Yan Z, Weich HA, Bernart W, Breckwoldt M, Neulen J. Vascular endothelial growth factor (VEGF) messenger ribonucleic acid (mRNA) expression in luteinized human granulosa cells in vitro. J Clin Endocrinol Metab. 1993;77:1723-25.

Elchalal U, Schenker JG. The pathophysiology of ovarian hyperstimulation syndrome-views and ideas. Hum Reprod. 1997;12(6):1129-37.

Farkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, et al. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res. 2020;13(1):25.

M. Al-Ramahi, Severe OHSS: Decreasing the risk of severe ovarian hyperstimulation syndrome. Human Reproduction. 1999;14(1):2421-2.

Sayyadi A, Mahdavi M, Dalfardi B, Karami Robati F, Shafiepour M. Right atrial thrombus and pulmonary thromboembolism related to ovarian hyperstimulation syndrome: A case report and literature review. Clin Case Rep. 2023;11(3):e7018.

Abou Arkoub R, Xiao CW, Claman P, Clark EG. Acute Kidney Injury Due to Ovarian Hyperstimulation Syndrome. Am J Kidney Diseases: Off J Natl Kidney Foundation. 2019;73(3):416-20.

Mor YS, Schenker JG. Ovarian hyperstimulation syndrome and thrombotic events. Am J Reprod Immunol 2014;72(06):541-8.

Namavar Jahromi B, Parsanezhad ME, Shomali Z, Bakhshai P, Alborzi M, Moin Vaziri N, et al. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. Iran J Med Sci. 2018;43(3):248-60.

Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52.

Diaz Ayllon H, Hernandez OL, Nagi T, Cespedes CM. Severe Ovarian Hyperstimulation Syndrome in the Setting of In Vitro Fertilization Treatment. Cureus. 2023;15(6):e39939.

Mathur RS, Joels LA, Jenkins JM. Ovarian hyperstimulation syndrome may be more likely if multiple pregnancy occurs following assisted conception. Acta Genet Med Gemellol (Roma). 1995;44(3-4):233-5.

Suzuki H, Matsubara S, Uchida S, Ohkuchi A. Ovary hyperstimulation syndrome accompanying molar pregnancy: case report and review of the literature. Arch Gynecol Obstet. 2014;290(4):803-6.

Rastin Z, Ghomian N, Khadem-Rezaiyan M. Severe Ovarian Hyperstimulation Syndrome in A Spontaneous Pregnancy with Normal Singleton Fetus: A Case Report. Iran J Nurs Midwifery Res. 2019;24(4):310-2.

Boroujeni MB, Boroujeni NB, Gholami M. The effect of progesterone treatment after ovarian induction on endometrial VEGF gene expression and its receptors in mice at pre-implantation time. Iran J Basic Med Sci. 2016;19(3):252-7.

Makino H, Furui T, Shiga T, Takenaka M, Terazawa K, Morishige KI. Management of ovarian hyperstimulation syndrome with abdominal compartment syndrome, based on intravesical pressure measurement. Reprod Med Biol. 2016;16(1):72-6.

Chen CD, Wu MY, Chao KH, Lien YR, Chen SU, Yang YS. Update on management of ovarian hyperstimulation syndrome. Taiwan J Obstet Gynecol. 2011;50(1):2-10.

Kılıç N, Özdemir Ö, Başar HC, Demircan F, Ekmez F, Yücel O. Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles: A randomized controlled study. Avicenna J Med. 2015;5(4):123-7.

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. J Assist Reprod Genet. 2012;29(3):259-64.

Casals G, Fábregues F, Pavesi M, Arroyo V, Balasch J. Conservative medical treatment of ovarian hyperstimulation syndrome: a single center series and cost analysis study. Acta Obstet Gynecol Scand. 2013;92(6):686-91.

Rova K, Passmark H, Lindqvist PG. Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles. Fertil Steril. 2012;97(1):95-100.

Ganer Herman H, Mizrachi Y, Horowitz E, Weissman A, Sabban B, Gluck O, et al. Obstetric outcomes following ovarian hyperstimulation syndrome in IVF-a comparison with uncomplicated fresh and frozen transfer cycles. BMC Pregnancy Childbirth. 2022;22(1):573.

Lensen SF, Wilkinson J, Mol BWJ, La Marca A, Torrance H, Broekmans FJ. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing IVF/ICSI. Cochrane Database Syst Rev. 2017;2017(6):CD012693.

Alyasin A, Mehdinejadiani S, Ghasemi M. GnRH agonist trigger versus hCG trigger in GnRH antagonist in IVF/ICSI cycles: A review article. Int J Reprod Biomed. 2016;14(9):557-66.

D'Angelo A, Amso NN, Hassan R. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2017;5(5):CD002811.

Downloads

Published

2024-08-29

How to Cite

Mohapatra, I., & Subha Ranjan. (2024). Navigating the complexities of pregnancy with ovarian hyperstimulation syndrome: an in-depth narrative exploration. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(9), 2590–2597. https://doi.org/10.18203/2320-1770.ijrcog20242528

Issue

Section

Review Articles