Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention

Area of Science:

• Reproductive endocrinology and infertility.
• Clinical trial methodology and evidence synthesis.

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a significant complication of controlled ovarian stimulation.
• Accurate prediction and effective prevention strategies are crucial for patient safety and successful fertility treatments.

Purpose of the Study:

• To systematically review and summarize evidence on OHSS pathophysiology, staging, prediction, and prevention.
• To identify reliable methods for predicting high ovarian response and OHSS occurrence.
• To evaluate interventions aimed at reducing OHSS incidence.

Main Methods:

• Conducted two systematic reviews focusing on prediction methods and preventive interventions for OHSS.
• Included studies examining pathophysiology, staging criteria, and randomized controlled trials (RCTs) of interventions.
• Synthesized evidence quality for predictive tools and preventive strategies.

Main Results:

• Antral follicle count and anti-Müllerian hormone levels are optimal for predicting high ovarian response.
• High ovarian response is the best predictor of OHSS development.
• High-quality evidence supports GnRH agonists and recombinant LH over hCG for prevention; moderate evidence supports antagonist protocols, dopamine agonists, and mild stimulation.

Conclusions:

• Effective tools exist for predicting OHSS and interventions for its prevention.
• Understanding these tools and interventions is vital for managing OHSS and maintaining high pregnancy rates.
• Further research may refine existing strategies and explore novel preventive measures.