Lifesaving dose increment of cabergoline in life-threatening spontaneous ovarian hyperstimulation syndrome resistant to all interventions

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a rare,life-threatening serious complication of ovulation induction with human chorionic gonadotropin (hCG). (4) 3% of patients undergoing IVF (in vitro fertilisation) develop OHSS. But radiologically evident pleural effusions develop only in 1% among which hemorrhagic effusions are very rare (1). Pleural effusions due to OHSS are usually associated with ascites. Isolated unilateral pleural effusions are uncommon. (2,3) The syndrome occurs in the luteal phase or during early part of pregnancy. The syndrome was first described in 1941 and the first fatal case of OHSS with renal failure and death was described in 1951.

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An Unusual Cause of Stroke: Internal Carotid Artery Occlusion as a Complication of Ovarian Hyperstimulation Syndrome

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791201900606 ◽

2012 ◽

Vol 19 (6) ◽

pp. 408-410

Author(s):

B Bayram ◽

O Limon ◽

G Limon ◽

S Akay

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Internal Carotid ◽

Healthy Woman ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Cerebral Stroke ◽

Ovarian Hyperstimulation ◽

Middle Cerebral Artery Infarction ◽

Life Threatening ◽

Severe Ohss

Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation. Thromboembolic events are the most feared complication of OHSS. Most of the thrombotic events (75%) are of the venous origin. Stroke represents a rare but life-threatening complication of severe OHSS. A 29-year old woman was admitted to our emergency room, with left sided weakness, difficulty in breathing and nausea. The patient was given the diagnosis of OHSS and right middle cerebral artery infarction. Here we emphasise that the development of ovulation induction is a newly recognised cause of cerebral stroke in an otherwise healthy woman.

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Life-threatening complications among women with severe ovarian hyperstimulation syndrome

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.02.009 ◽

2019 ◽

Vol 220 (6) ◽

pp. 575.e1-575.e11 ◽

Cited By ~ 3

Author(s):

Jessica Selter ◽

Timothy Wen ◽

Katherine L. Palmerola ◽

Alexander M. Friedman ◽

Zev Williams ◽

...

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Life Threatening ◽

Severe Ovarian Hyperstimulation Syndrome

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Fatal ovarian hyperstimulation syndrome in an anonymous egg donor

Medico-Legal Journal ◽

10.1177/0025817216665074 ◽

2016 ◽

Vol 84 (4) ◽

pp. 219-223 ◽

Cited By ~ 2

Author(s):

Shashank Pooniya ◽

C Behera ◽

AR Mridha ◽

DN Bhardwaj ◽

Tabin Millo

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Medical Negligence ◽

Assisted Reproduction Techniques ◽

Vitro Fertilization ◽

Egg Donor ◽

Legal Literature ◽

Life Threatening ◽

Iatrogenic Disorder

Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature.

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Prevention of severe ovarian hyperstimulation syndrome in IVF with or without ICSI and embryo transfer: a modified `coasting' strategy based on ultrasound for identification of high-risk patients

Human Reproduction ◽

10.1093/humrep/16.1.24 ◽

2001 ◽

Vol 16 (1) ◽

pp. 24-30 ◽

Cited By ~ 54

Author(s):

T. Al-Shawaf ◽

A. Zosmer ◽

S. Hussain ◽

A. Tozer ◽

N. Panay ◽

...

Keyword(s):

At Risk ◽

High Risk ◽

Ovarian Hyperstimulation Syndrome ◽

Pregnancy Rates ◽

Ovarian Hyperstimulation ◽

Ultrasound Monitoring ◽

Patients At Risk ◽

Risk Patients ◽

Life Threatening ◽

Severe Ohss

Abstract Ovarian hyperstimulation syndrome (OHSS) can be a severe and potentially life-threatening complication of ovarian stimulation for IVF. Coasting or withholding gonadotrophin stimulation relies on frequent estimation of serum oestradiol to identify patients at risk. A modified coasting protocol was developed in which identification of patients at risk of severe OHSS was based on ultrasound monitoring. Serum oestradiol concentrations were measured only in patients with >20 follicles on ultrasound (high risk). If serum oestradiol concentrations were <3000 pmol/l, the gonadotrophin dose was maintained; if concentrations were ≥3000 pmol/l but <13200 pmol/l and ≥25% of the follicles had a diameter of ≥13 mm, the gonadotrophin dose was halved; and if serum oestradiol concentrations were ≥13 200 pmol/l and ≥25% of the follicles had a diameter of ≥15 mm, patients were coasted. In the latter group, human chorionic gonadotrophin (HCG) 10000 IU was administered when at least three follicles had a diameter of ≥18 mm and serum oestradiol concentrations were <10000 pmol/l. Over a 10 month period, serum oestradiol concentrations were measured in 123 out of 580 cycles (24%) and in 50 cycles, gonadotrophins were withheld. Overall, moderate OHSS occurred in three patients (0.7%) and severe OHSS in one patient (0.2%). The pregnancy rates in the cycles where the gonadotrophin dose was reduced or withheld were 39.6 and 40% per cycle respectively; corresponding implantation rates were 30.7 and 25.6%. It is concluded that the modified coasting strategy is associated with a low risk of moderate and severe OHSS to a minimum without compromising pregnancy rates. Identification of patients at risk by ultrasound reduces the number of serum oestradiol measurements and thus inconvenience to patients as well as costs and workload.

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Spontaneous Ovarian Hyperstimulation Syndrome in a Triplet Pregnancy

Case Reports in Critical Care ◽

10.1155/2012/189705 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Nisha Rani Agrawal ◽

Garima Gupta ◽

Kusum Verma ◽

Neeraj Varyani

Keyword(s):

Ovulation Induction ◽

Ovarian Hyperstimulation Syndrome ◽

Clinical Presentation ◽

Rare Event ◽

Ovarian Hyperstimulation ◽

Triplet Pregnancy ◽

Life Threatening ◽

Life Threatening Complication ◽

Strong Suspicion

Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication, usually iatrogenic after ovulation induction. OHSS is a very rare event in spontaneously conceived pregnancies. Only few cases have been reported in literature to the best of our knowledge. We report a very rare case of spontaneous critical OHSS (according to classification of severity of OHSS as mentioned in Greentop guidelines no. 5, 2006) associated with triplet pregnancy in a 26-year-old woman suffering from severe abdominal pain, distension, and dyspnea. Our case highlights the importance of a strong suspicion for OHSS when a clinical presentation could not be explained by common medical conditions.

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Obstetric and fertility patients

10.1093/med/9780199696277.003.0013 ◽

2013 ◽

Author(s):

Martin Beed ◽

Richard Sherman ◽

Ravi Mahajan

Keyword(s):

Critical Illness ◽

Hellp Syndrome ◽

Ovarian Hyperstimulation Syndrome ◽

Thromboembolic Disease ◽

Major Haemorrhage ◽

Ovarian Hyperstimulation ◽

Care Intervention ◽

Obstetric Haemorrhage ◽

Life Threatening ◽

In Pregnancy

Critical illness in pregnancySevere pre-eclampsia/eclampsiaHELLP syndromeAnaphylactoid syndrome of pregnancyMassive obstetric haemorrhageOvarian hyperstimulation syndromeAny critical illness may complicate pregnancy, or the postpartum period; especially sepsis and thromboembolic disease. Pregnancy-related illnesses may also require critical care intervention, including: pre-eclampsia and eclampsia, the HELLP syndrome, major haemorrhage, and anaphylactoid syndrome of pregnancy (amniotic fluid embolism). As with any critical illness, life-threatening problems are identified and treated first....

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Life-threatening forms of ovarian hyperstimulation syndrome and intensive care of the ovarian hyperstimulation syndrome patient

Ovarian Hyperstimulation Syndrome ◽

10.1201/9780203018873-24 ◽

2006 ◽

pp. 185-194

Keyword(s):

Intensive Care ◽

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Syndrome Patient ◽

Life Threatening

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Ovarian Hyperstimulation Syndrome on the Acute Medical Unit: A problem-based review

Acute Medicine Journal ◽

10.52964/amja.0407 ◽

2015 ◽

Vol 14 (1) ◽

pp. 21-27

Author(s):

Rebeca Carter ◽

◽

Kyle Petrie ◽

Ashkan Sadighi ◽

Hannah Skene ◽

...

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Signs And Symptoms ◽

In Vitro Fertilisation ◽

Ovarian Hyperstimulation ◽

Care Services ◽

Acute Medical Unit ◽

Life Threatening ◽

Acute Care Services ◽

The Uk

Ovarian Hyperstimulation Syndrome (OHSS) is a spectrum of clinical features typically resulting from assisted conception techniques. With 2.35% of all live births in the UK resulting from in-vitro fertilisation (IVF), OHSS is on the rise. Moreover, there has been an increase in the presentation of its complications to GP surgeries and unscheduled acute care services nationwide. This review will discuss signs and symptoms of the increasingly common and potentially fatal complications of OHSS, namely pleural effusion, ascites and thromboembolic events. With such propensity toward critical, life-threatening events it is not only prudent to recognise the population at risk, but also to be aware of the signs, symptoms and complications to expedite treatment and ensure optimum outcome.

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Successful reversal of ovarian hyperstimulation syndrome in a mouse model by rapamycin, an mTOR pathway inhibitor

MHR Basic science of reproductive medicine ◽

10.1093/molehr/gaz033 ◽

2019 ◽

Vol 25 (8) ◽

pp. 445-457 ◽

Cited By ~ 1

Author(s):

Wenwen Liu ◽

Chi Zhang ◽

Lu Wang ◽

Xuan Huang ◽

Jing Zhang ◽

...

Keyword(s):

Mouse Model ◽

Signaling Pathway ◽

Ovarian Hyperstimulation Syndrome ◽

Mtor Signaling ◽

Ovarian Hyperstimulation ◽

Matrix Remodeling ◽

Mtor Signaling Pathway ◽

Functional Roles ◽

Life Threatening ◽

Endothelial Growth Factor

Abstract Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening, iatrogenic complication of ovarian stimulation in assisted reproduction technology. This complex syndrome is characterised by enlarged ovaries with multiple corpora luteum, elevated sex steroid hormones in serum and increased capillary permeability. Until now, the pathogenesis of OHSS remains obscure, and no absolute strategy can fully prevent OHSS without any side effect on ovulation and clinical pregnancy. Using cultured human or mouse granulosa cells, our study revealed the time-dependent activation of the mTOR signaling pathway after human chorionic gonadotropin (hCG) treatment. The involvement of the mTOR signaling pathway was also observed in the development of OHSS in a mouse model. Selectively inhibiting mTOR signals by only two injections of rapamycin (2 mg/kg body weight), before or just after hCG treatment, significantly reduced vascular leakage and the severity of OHSS symptoms. Although ovarian angiogenesis was significantly inhibited, rapamycin could not decrease the elevated levels of vascular endothelial growth factor, IL-6 and IL-11 in OHSS ovaries. Further study showed the functional roles of the mTOR signaling pathway in the hyperstimulation-induced ovarian extracellular matrix remodeling as the expression of α2M, a broad proteolytic inhibitor in both ovary and serum, was dramatically decreased after rapamycin treatment. Since a single injection of rapamycin during superovulation had no side effects on ovulation and early embryonic development, we propose rapamycin may be a good candidate to lower and prevent the risk of OHSS in the future.

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