Prevention is the ideal treatment of OHSS!!!

Ovarian hyperstimulation syndrome (OHSS) is a unique iatrogenic complication of controlled ovarian stimulation (COH)/in vitro fertilization (IVF) in reproductive endocrinology occurring during the luteal phase or early pregnancy. It can have a serious impact on the patient’s health. With the expansion of the assisted reproductive techniques (ART) from 1978, the incidence of OHSS is increasing worldwide.OHSS is characterized by gastrointestinal symptoms, ovarian enlargement, fluid shift to the third space, and hemoconcentration. Severe cases are associated with thromboembolic phenomena, respiratory distress, liver dysfunction and renal failure. OHSS is more common among woman who are young, thin and have PCOS or multiple allergies. Vascular endothelial growth factor (VEGF) and other cytokines are pivotal in the pathogenesis of OHSS. In the prevention of any disease, it should be emphasized that the possibility of primary prevention depends on two main requirements, first, the etiology of the disease and predisposing factors; and second, it must be feasible to avoid or manipulate such factors as paint of a prevention strategy. This strategy for preventing OHSS and its severity have included prediction of women at risk; the first step in prevention is identification of patients at risk by the recognition of risk factors. As this is not always possible, there are several ways of avoiding developing of the syndrome. The stimulation phase has to be carefully monitored (regular ultrasound and estradiol measurements), and further interventions need to be implemented if signs of hyper-response are present. The aim of this systemic review of the literature is to answer this question: “can we prevent severe OHSS”. Canceling the cycle, modification of method to trigger ovulation administration of macromolecules, coasting approach, timed unilateral or bilateral aspiration of one or two ovaries performed before or after hCG administration, In vitro maturation (IVM), elective cryopreservation of all embryos, and laser or electrocautery of one or both ovaries, have been showed to be associated with a reduced risk of OHSS by some research groups. The effect of combined method should be assessed. Finally, apart from canceling, none of these approaches was totally efficient, although most of the above-mentioned methods decrease the incidence in patients at high risk of OHSS, but overall “prevention is the ideal treatment of OHSS”.