Prevention and management of ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) may occur following luteinisation in cycles of ovarian stimulation, especially in predisposed women. Choice of lower-risk treatments and modifying the dose of gonadotrophins in women at high risk of OHSS may aid prevention. Cycles where ovarian response is excessive may be managed by withholding gonadotrophins until the response settles. Avoiding or minimising luteal human chorionic gonadotrophin exposure, by cryopreservation of all embryos or progesterone luteal support, also reduces the risk. Mild OHSS requires reassurance and outpatient monitoring as the severity may worsen, particularly if pregnancy occurs. Hospital admission is indicated for specific criteria, and management includes pain relief, thromboprophylaxis and fluid balance. Non-steroidal agents should be avoided. Fluid replacement should be oral whenever possible. Abdominal paracentesis is indicated in the presence of tense ascites and severe symptoms. Patients should be counselled that the condition is self-limiting and that the effect on coincidental pregnancy remains unclear.