Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome.
Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS.



The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers.



More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.
aIVF Australia, Greenwich bDepartment of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, Australia.
Michele
M
Kwik
Elizabeth
E
Maxwell
D054304:Anti-Mullerian Hormone / Q000378:metabolism; D006063:Chorionic Gonadotropin / Q000378:metabolism; D019317:Evidence-Based Medicine; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D010062:Ovulation Induction / Q000009:adverse effects*; D060728:Reproductive Health; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D006063:Chorionic Gonadotropin; D006727:Hormone Antagonists; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007987:Gonadotropin-Releasing Hormone; D054304:Anti-Mullerian Hormone