Ovarian hyperstimulation syndrome

De, L. A., MontaneUi, L., Van, D. J., et al. (2006) Presence and absence of foUicle-stimulating hormone receptor mutations provide some insights into spontaneous ovarian hyperstimulation syndrome physiopathology. J. Clin. Endocrinol. Metab. 91, 555-562. 

In women treated with gonadotropins and hCG, the two most serious complications are the ovarian hyperstimulation syndrome and multiple pregnancies. Overstimulation of the ovary during ovulation induction often leads to... 

Follitropin alfa Activates FSH receptors Mimics effects of endogenous FSH Controlled ovulation hyperstimulation in women infertility due to hypogonadism in men SC injection 3-7 x/wk Toxicity Ovarian hyperstimulation syndrome and multiple pregnancies in women gynecomastia in men headache, depression, edema in both sexes... 

In 71 women undergoing in vitro fertilization and embryo transfer using recombinant human follicle-stimulating hormone in doses sufficient to attain a pregnancy rate of 24% (10), the main adverse effect was mild pain at the site of injection (less than 20% of patients) but there were two cases of ovarian hyperstimulation syndrome. In less than 10% of patients, redness, swelling, or bruising was seen and one patient developed headache. 

When recombinant and urinary versions of follicle-stimulating hormone were compared under double-blind conditions in an in vitro fertilization program in a randomized, multicenter study (12), the former was more potent. There were no clinically relevant differences in safety between the two products and no cases of ovarian hyperstimulation syndrome. 

More exact data on the adverse effects and relative safety of the recombinant and urinary formulations have been provided in a similar investigation in 259 women (15). In terms of safety, rhCG was well tolerated at a dose of up to 30 000 IU. Moderate ovarian hyperstimulation syndrome was reported in 12% of patients who received uhCG and 12% of those who received two injections of rhCG. There were no moderate or severe... 

Urine-derived urofollitropin and recombinant FSH appear to be equally effective and well tolerated for induction of ovulation (34). However, it is unclear whether human menopausal gonadotropins have a higher risk of overstimulation and ovarian hyperstimulation syndrome than urofollitropin in women with polycystic ovary syndrome. 

Engel T, Jewelewicz R, Dyrenfurth I, Speroff L, Vande Wiele RL. Ovarian hyperstimulation syndrome. Report of a case with notes on pathogenesis and treatment. Am J Obstet Gynecol 1972 112(8) 1052-60. 

Samman Y, Ghoneim H, Hashim IA. Syndrome of inappropriate ADH as a manifestation of severe ovarian hyperstimulation syndrome. J Obstet Gynaecol 2001 21 201-3. 

Borgaonkar MR, Marshall JK. Marked elevation of serum transaminases may be associated with ovarian hyperstimulation syndrome. Am J Gastroenterol 1999 94(11) 3373. 

Evbuomwan IO, Fenwick JD, Shiels R, Herbert M, Murdoch AP. Severe ovarian hyperstimulation syndrome following salvage of empty follicle syndrome. Hum Reprod 1999 14(7) 1707-9. 

Davis AJ, Pandher GK, Masson GM, Sheron N. A severe case of ovarian hyperstimulation syndrome with liver dysfunction and malnutrition. Eur J Gastroenterol Hepatol 2002 14(7) 779-82. 

Garrett CW, Gaeta TJ. Ovarian hyperstimulation syndrome acute onset dyspnea in a young woman. Am J Emerg Med 2002 20(1) 63 1. 

Al-Shawaf T, Grudzinskas JG. Prevention and treatment of ovarian hyperstimulation syndrome. Best Pract Res Clin Obstet Gynaecol 2003 17 249-61. 

Tozer AJ, lies RK, Iammarrone E, Gillott CMY, Al-Shawaf T, Grudzinskas JG. The effects of coasting on follicular fluid concentrations of vascular endothelial growth factor in women at risk of developing ovarian hyperstimulation syndrome. Hum Reprod 2004 19 522-8. 

Gnoth C, Halbe E, Freundl G. Persistent ascites after ovarian hyperstimulation syndrome and administration of mifepristone (RU 486) for the termination of pregnancy. Arch Gynecol Obstet 2003 268 65-8. 

Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Ross R, Morris S. Effects of the ovulatory serum concentration of human chorionic gonadotropin on the incidence of ovarian hyperstimulation syndrome and success rates for in vitro fertilization. Fert Steril 2005 84 93-8. 

Braude P, Rowell P, Taylor A. ABC of subfertility. Assisted conception. Ill—Problems with assisted conception. Ovarian hyperstimulation syndrome. BMJ 2003 327 920. 

Watanabe T. Early prediction of ovarian hyperstimulation syndrome during gonadotropin therapy by means of a damped oscillation rheometer. Biorheology 2002 39 767-86. 

Ludwig M, Tolg R, Richardt G, Katus HA, Diedrich K. Myocardial infarction associated with ovarian hyperstimulation syndrome. JAMA 1999 282(7) 632-3. 

A 32-year-old woman who was not obese developed benign intracranial hypertension in association with ovarian hyperstimulation syndrome after ovulation induction using goserelin, follitropin, and human chorionic gonadotropin (hCG) (3). The syndrome did not recur during a second pregnancy in which follitropin and hCG were not used... 

Lesny P, Maguiness SD, Hay DM, Robinson J, Clarke CE, Killick SR. Ovarian hyperstimulation syndrome and benign intracranial hypertension in pregnancy after in-vitro fertilization and embryo transfer case report. Hum Reprod 1999 14(8) 1953-5. 

Ovarian hyperstimulation syndrome occurred in a woman with polycystic ovarian syndrome, 3 weeks after an intramuscular injection of leuprorelin acetate for endometriosis (68). She was later given further courses of the drug without this complication. 

Whelan JG 3rd, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril 2000 73(5) 883-96. 

Beerendonk CC, van Dop PA, Braat DD, Merkus JM. Ovarian hyperstimulation syndrome facts and fallacies. Obstet Gynecol Surv 1998 53(7) 439-49. 

Abramov Y, Elchalal U, Schenker JG. Febrile morbidity in severe and critical ovarian hyperstimulation syndrome a multicentre study. Hum Reprod 1998 13(11) 3128-31. 

Uhler ML, Budinger GR, Gabram SG, Zinaman MJ. Perforated duodenal ulcer associated with ovarian hyperstimulation syndrome Case Report. Hum Reprod 2001 16(l) 174-6. 

Jirecek S, Nagele F, Huber JC, Wenzl R. Ovarian hyperstimulation syndrome caused by GnRH-analogue treatment without gonadotropin therapy in a patient with polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1998 77(9) 940-1. 

Loret de Mola JR, Kiwi R, Austin C, Goldfarb JM. Subclavian deep vein thrombosis associated with the use of recombinant follicle-stimulating hormone (Gonal-F) complicating mild ovarian hyperstimulation syndrome. Fertil Steril 2000 73(6) 1253-6. 

Yoshii F, Ooki N, Shinohara Y, Uehara K, Mochimaru F. Multiple cerebral infarctions associated with ovarian hyperstimulation syndrome. Neurology 1999 53(1) 225—7. 

Worrell GA, Wijdicks EF, Eggers SD, Phan T, Damario MA, Mullany CJ. Ovarian hyperstimulation syndrome with ischemic stroke due to an intracardiac thrombus. Neurology 2001 57(7) 1342 1. 

Ovarian hyperstimulation syndrome is far less common with gonadorelin receptor antagonists than agonists in induction of ovulation (2,7). Hot flushes are rare, in contrast to gonadorelin receptor agonists in a prospective, uncontrolled study of 346 women given cetrorelix, there was only one case of hot flushes (7). 

Albumin has been used to prevent the ovarian hyperstimulation syndrome (OHSS) associated with ovulation stimulation. In 98 women albumin had no positive effect on OHSS (3). Because of adverse effects, such as exacerbation of ascites in OHSS, nausea, vomiting, febrile reactions, allergic reactions, anaphylaxis, and the risk of... 

---