Full Description
Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication of ovarian stimulation in women undergoing in vitro fertilization (IVF). It is triggered solely by human chorionic gonadotrophin (hCG), used for final oocyte maturation (early OHSS), or by endogenous hCG produced by the implanted blastocyst (late OHSS). Although its incidence may have decreased due to advances in ovarian stimulation protocols, OHSS remains a significant concern in the context of rising global ART cycles. This text, authored by eminent international experts, comprehensively explores OHSS, with a focus on prevention, complications, and treatment strategies, incorporating the latest scientific advances.
• Offers a state-of-the-art overview of all clinical aspects of OHSS
• Provides focused OHSS guidance for gynecologists, reproductive specialists and healthcare professionals
• Highlights the role of modern ovarian stimulation protocols in reducing OHSS
Tryfon G. Lainas MD, PhDReproductive Gynecologist, Clinical Director at Eugonia ART Unit, Athens, Greece
Former Board Member, Hellenic Society of Fertility and Sterility
Former Head, Department of Endoscopic Surgery, IASO Maternity Hospital Athens, Greece
George Lainas MD, PhD
Reproductive Gynecologist, Scientific Director at Eugonia ART Unit, Athens, Greece
Associate Editor, Human Reproduction Update
Past Coordinator, ESHRE Special Interest Group on Reproductive Endocrinology
Member, ESHRE Guideline Development Groups: Ovarian Stimulation, RIF, ART Clinic KPIs, Periconceptional Care
Contents
Part 1 Introduction: Definition 1.1 ART and OHSS Development (Early-Late) 1.2 Clinical Manifestations of Ovarian Hyperstimulation Syndrome 1.3 Epidemiology of OHSS 1.4 Complications of Ovarian Hyperstimulation Syndrome Part 2 Pathophysiology of OHSS 2.1 Pathophysiology of Ovarian Hyperstimulation Syndrome: The Role of Corpus Luteum and Vascular Permeability 2.2 Genetic Causes of OHSS Part 3 Classification of OHSS 3.1 Ovarian Hyperstimulation Syndrome: Historical Classification Systems 3.2 Modern OHSS Classification Systems Part 4 Prediction of OHSS 4.1 Risk Factors for OHSS 4.2 OHSS Prediction Part 5 Primary Prevention: OHSS Reduction Strategies 5.1 Types and Doses of Gonadotrophins and Alternative Strategies to Reduce OHSS Incidence 5.2 Coasting and hCG Dose Reduction 5.3 Gonadotropin-Releasing Hormone (GnRH) Antagonist Protocols 5.4 Embryo and Oocyte Cryopreservation 5.5 In Vitro Maturation - Navigating Success and Safety Part 6 Secondary Prevention: OHSS Elimination Strategies 6.1 GnRH Agonist Triggering and "Freeze-All" Strategy 6.2 Navigating through OHSS with GnRH Agonist Triggers and Low-Dose hCG for Luteal Support 6.3 OHSS Elimination: Alternative Agents for Final Oocyte Maturation Part 7 Tertiary Prevention: Outpatient Management 7.1 Luteal GnRH Antagonist Administration for Management of Established Severe OHSS 7.2 Dopamine Agonists 7.3 Glucocorticoids and OHSS Part 8 Management of Established OHSS 8.1 Management of Late OHSS 8.2 Criteria for Hospitalization and Inpatient Management
