Ovarian hyperstimulation syndrome (OHSS) - our clinical experience

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic termination of pregnancy was done wherever indicated. The women were discharged after the reversal in a satisfactory condition. Results: 62.5% patients presented with early onset hyperstimulation. 31.25% patients presented with mild, 43.75% with moderate, 12.5% each with severe and critical OHSS. Polycystic ovarian disease was present in 60% women. 62.5% had pleural effusion. Intrauterine gestational sacs were one, two and three in 37.5%, 31.25 % and 12.5% patients respectively. 12.5% patients had haemoglobin more than 13 gm/dl and 25% had haematocrit more than 45%. 31.25% patients had decreased urine output. Pleuracentesis alone was done in 25% and paracentesis in 50% patients and both in 12.5%. The pregnancies continued in 87.5%. Conclusion: Although OHSS cannot always be prevented; various parameters should be taken into consideration to prevent it. The patients with OHSS must be urgently treated and with multidisciplinary management. If left untreated, OHSS can result in serious health complications and even death.