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Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoin...

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Detalles Bibliográficos
Autores principales: Fiedler, Klaus, Ezcurra, Diego
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403873/
https://www.ncbi.nlm.nih.gov/pubmed/22531097
http://dx.doi.org/10.1186/1477-7827-10-32
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author Fiedler, Klaus
Ezcurra, Diego
author_facet Fiedler, Klaus
Ezcurra, Diego
author_sort Fiedler, Klaus
collection PubMed
description Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF), to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use.
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spelling pubmed-34038732012-07-25 Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment Fiedler, Klaus Ezcurra, Diego Reprod Biol Endocrinol Review Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF), to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use. BioMed Central 2012-04-24 /pmc/articles/PMC3403873/ /pubmed/22531097 http://dx.doi.org/10.1186/1477-7827-10-32 Text en Copyright ©2012 Fiedler and Ezcurra; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Fiedler, Klaus
Ezcurra, Diego
Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title_full Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title_fullStr Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title_full_unstemmed Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title_short Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment
title_sort predicting and preventing ovarian hyperstimulation syndrome (ohss): the need for individualized not standardized treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403873/
https://www.ncbi.nlm.nih.gov/pubmed/22531097
http://dx.doi.org/10.1186/1477-7827-10-32
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