Ovarian hyperstimulation syndrome Flashcards
(11 cards)
What is ovarian hyperstimulation syndrome?
A complication of ovarian stimulation during IVF treatment associated with using hCG to mature the follicles during the final steps of ovarian stimulation.
What is the pathophysiology of ovarian hyperstimulation syndrome?
Increase in vascular endothelial growth factor released by granulosa cells of the follicles as VEGF increases vascular permeability, causing fluid to leak from capillaries from intra to extravascular space = oedema, ascites & hypovolaemia.
Why does ovarian hyperstimulation syndrome occur after the ‘trigger injection’ (hCG injection)?
As hCG stimulates the release of VEGF from the follicles.
What is associated with ovarian hyperstimulation syndrome?
Raised renin as the RAAS system is activated - higher the renin, more severe the condition.
What are the risk factors for ovarian hyperstimulation syndrome?
Younger age, lower BMI, raised anti-Mullerian hormone, PCOS, raised oestrogen levels during stimulation.
How is ovarian hyperstimulation syndrome prevented?
Assess risk - if high risk use GnRH antagonist over agonist, lower doses of gonadotrophins and hCG. During stimulation, monitor serum oestrogen and USS the follicles (higher number & larger size = higher risk).
How do you classify ovarian hyperstimulation syndrome as mild?
Abdominal pain & bloating.
How do you classify ovarian hyperstimulation syndrome as moderate?
N&V with ascites on USS.
How do you classify ovarian hyperstimulation syndrome as severe?
Ascites, oliguria, low serum albumin, high potassium & raised haematocrit.
How do you classify ovarian hyperstimulation syndrome as critical?
Tense ascites, anuria, thromboembolism & ARDS.
What is the management for ovarian hyperstimulation syndrome?
Oral fluids, monitor urine output, LMWH (to prevent thromboembolism), paracentesis (ascitic fluid removal), IV colloids.
