Prevention of Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is rare but most serious complication of ovarian stimulation. Symptoms are mainly related to increased capillary permeability leading to extravasation of fluid intoextravascular compartment. Disease pathophysiology is linked to hCG (human chorionic gonadotropin) which acts through angiogenic molecule vascular endothelial growth factor (VEGF). There is recent development of interestin use of dopamine agonist for prevention of OHSS, which act through blockage of VEGF by preventing phosphorylation of VEGF-2 receptor. Once there is full blown OHSS, treatment is mainly symptomatic. By careful selection of stimulation protocols & recognisition of high risk cases at an early stage, early OHSS can be prevented to a major extent. Use of GnRH antagonist protocols & GnRH agonist as final trigger leads to marked reduction in incidence of OHSS without compromising pregnancy rates. So, prevention has been mainstay of treatment for this rarebut life-threatening iatrogenic complication of ovarian stimulation.