Update on ovarian hyperstimulation syndrome: Part 1--Incidence and pathogenesis.
Ovarian hyperstimulation syndrome (OHSS) is a rare and potentially life-threatening complication during controlled ovarian stimulation. It can be associated with severe morbidity and may even be fatal. The etiology of the condition and predisposing factors are still not fully understood. Data concerning pathophysiology in patients with OHSS were searched using PubMed and other medical data bases. The incidence of severe OHSS, as calculated by World Health Organization (WHO), is 0.2-1% of all stimulation cycles in assisted reproduction. Considerations on OHSS classifications and forms of manifestations are discussed in detail. New insights concerning genetics and altered FSH receptor are given. OHSS may involve, according to its grade of severity, elevated or decreased levels of growth factors, cytokines, mediators, changes in hormones, renin-angiotensin and kinin-kallikrein system. There are massive electrolytic imbalances and changes in hemodynamic and fluid metabolism. Furthermore, liver and pulmonary dysfunction is observed as well as increased coagulation with subsequent thromboembolism. The influence of OHSS on the pregnancy rate and outcome of pregnancy is a matter of controversy. Patients with OHSS have high pregnancy rates with a tendency to an increased incidence of abortion.
Binder
Helge
H
Dept. of Gynecology, Erlangen University Hospital, Erlangen, Germany. helge.binder@gyn.imed.uni-erlangen.de
Dittrich
Ralf
R
Einhaus
Friedrich
F
Krieg
Jürgen
J
Müller
Andreas
A
Strauss
Richard
R
Beckmann
Matthias W
MW
Cupisti
Susanne
S
D016207:Cytokines / Q000378:metabolism; D019040:E-Selectin / Q000378:metabolism; D016228:Endothelial Growth Factors / Q000378:metabolism; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism; D016471:Ovarian Hyperstimulation Syndrome / Q000145:classification / Q000209:etiology / Q000628:therapy; D010062:Ovulation Induction / Q000009:adverse effects; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism; D016387:Women's Health; D014944:World Health Organization
D016207:Cytokines; D019040:E-Selectin; D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D012083:Renin