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Management of ovarian hyperstimulation syndrome

Cristiano E Busso, MD
Sérgio Reis Soares, MD
Antonio Pellicer, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kathryn A Martin, MD


Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction. It is characterized by a broad spectrum of signs and symptoms that includes abdominal distention and discomfort, enlarged ovaries, ascites, and other complications of enhanced vascular permeability. The syndrome can be strictly defined as the shift of serum from the intravascular space to the third space, mainly to the abdominal cavity, in the context of enlarged ovaries due to follicular stimulation. In its very severe form, OHSS is a life-threatening condition.

The management of OHSS will be reviewed here. The pathogenesis, clinical manifestations, and prevention of OHSS are discussed separately. (See "Pathogenesis, clinical manifestations, and diagnosis of ovarian hyperstimulation syndrome" and "Prevention of ovarian hyperstimulation syndrome".)


OHSS is an iatrogenic and potentially life-threatening condition that affects young, healthy women [1,2]. In addition, there is an important economic burden associated with OHSS due to absence from work, bed rest, or hospitalization and intensive medical management of severe cases.

The pathophysiology of OHSS is not fully understood, but increased capillary permeability with the resulting loss of fluid into the third space is its main feature. In the susceptible patient, human chorionic gonadotropin (hCG) administration for final follicular maturation and triggering of ovulation is the pivotal stimulus for OHSS, leading to overexpression of vascular endothelial growth factor (VEGF) in the ovary, release of vasoactive-angiogenic substances, increased vascular permeability, loss of fluid to the third space, and full-blown OHSS (algorithm 1).

There are two clinical forms of OHSS, both hCG related: the early-onset form (occurring on the first eight days after exogenous hCG administration) and the late-onset form (occurring nine or more days after hCG administration, related to pregnancy-induced hCG production) [3]. (See "Pathogenesis, clinical manifestations, and diagnosis of ovarian hyperstimulation syndrome", section on 'Onset'.)

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Literature review current through: Dec 2017. | This topic last updated: Jul 12, 2017.
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