OHSS

Question 1

Categories of OHSS

Answer 1

Question 2

Pathophysiology

Answer 2

The pathophysiology of OHSS is still hotly debated but triggering of increased capillary
permeability is probably the initial event. Several mediators for this response have been proposed including estradiol, prostaglandins and the ovarian renin-angiotensin system, but none of these have been proven. The most likely candidates would appear to be Vascular Endothelial Growth Factor (VEGF) which seems responsible for the increased capillary permeability resulting in ascitic fluid accumulation and interleukin 6 (IL-6) acting as an inflammatory cytokine. Angiogenin may also play a role in the neovascularisation of the ovary necessary for OHSS to develop

Question 3

Risk factors

Answer 3

Young age
Thin
PCOs
AMH elevated
plasma estradiol levels during COH act as a guide but do not correlate well with incidence of OHSS.
20 follicles > or = to 11 should be a freeze all cycle.