scholarly journals Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication

2017 ◽  
Vol 6 (3) ◽  
pp. 1154
Author(s):  
Vineet Mishra ◽  
Priyankur Roy ◽  
Sumesh Choudhary ◽  
Rohina Aggarwal ◽  
Shaheen Hokabaj ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Pulmonary Edema ◽  
Ovarian Hyperstimulation Syndrome ◽  
Rare Complication ◽  
Clomiphene Citrate ◽  
Controlled Ovarian Hyperstimulation ◽  
Ovarian Hyperstimulation ◽  
Treatment Regimens ◽  
Life Threatening ◽  
Severe Ohss

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS.Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment.Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach.

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

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.

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

2001 ◽  
Vol 16 (1) ◽  
pp. 24-30 ◽  
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.

scholarly journals Role of Serum miRNAs in the Prediction of Ovarian Hyperstimulation Syndrome in Polycystic Ovarian Syndrome Patients

2015 ◽  
Vol 35 (3) ◽  
pp. 1086-1094 ◽  
Author(s):  
Chun Zhao ◽  
Xiaoguang Liu ◽  
Zhonghua Shi ◽  
Jing Zhang ◽  
Junqiang Zhang ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Polycystic Ovarian Syndrome ◽  
Positive Association ◽  
Controlled Ovarian Hyperstimulation ◽  
Ovarian Hyperstimulation ◽  
Altered Expression ◽  
Serum Mirnas ◽  
Increased Risk ◽  
Ovarian Syndrome ◽  
Severe Ohss

Background: Polycystic ovarian syndrome (PCOS) causes a significantly increased risk of ovarian hyperstimulation syndrome (OHSS). Here, we focused on the altered expression of serum miRNAs and their predictive value for OHSS in PCOS patients. Methods: We used the TaqMan low density array followed by individual quantitative reverse transcription-polymerase chain reaction to identify and validate the expression of serum miRNAs in PCOS patients likely to develop severe OHSS. Results: The miR-16 and miR-223 expression levels were significantly reduced in the patients who were likely to develop severe OHSS than in the control subjects who were likely to develop mild or no OHSS. The sensitivity and specificity of the basal LH, basal LH/FSH, and body mass index (BMI) as OHSS predictors were also evaluated. miR-16 was the most efficient for OHSS prediction as it yielded the highest AUC. Logistic binary regression analyses revealed a positive association of miR-223 and BMI. Conclusion: Serum miRNAs are differentially expressed in PCOS patients likely to suffer from severe OHSS. We identified and validated two serum miRNAs that have potential for use as novel noninvasive biomarkers to accurately predict OHSS before controlled ovarian hyperstimulation (COH) for PCOS patients.

A Case Report: Acute Respiratory Distress in a Patient with Anemia

2021 ◽  
Vol 8 (6) ◽  
Author(s):  
Kotnala S ◽  
◽  
Wadhawan S ◽  
Parmar GM ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Respiratory Distress ◽  
Pulmonary Edema ◽  
Cardiogenic Pulmonary Edema ◽  
Unique Case ◽  
Proper Management ◽  
Life Threatening ◽  
Timely Treatment

Acute respiratory distress can be life threatening if proper management is delayed. The cause of respiratory distress needs to be diagnosed quickly in order to administer appropriate and timely treatment. However, it is sometimes difficult to tease out various conditions that can present as acute respiratory distress. We present such a unique case of acute respiratory distress in a patient with anemia. We show how the ability to differentiate between cardiogenic and non-cardiogenic pulmonary edema can help in diagnosis and appropriate timely management of acute respiratory distress.

Severe ovarian hyperstimulation syndrome with GnRH agonist trigger during the COVID pandemic: lessons learned from an unusual case

2021 ◽  
Vol 5 (04) ◽  
pp. 01-04
Author(s):  
Bradley S Hurst ◽  
Evan Schrader ◽  
Tanner Hurley ◽  
Lariena Welch ◽  
Ying Ying ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Unusual Case ◽  
Oocyte Retrieval ◽  
Lessons Learned ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Agonist Trigger ◽  
Severe Ohss

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

scholarly journals Prediction of severe ovarian hyperstimulation syndrome in women undergoing in vitro fertilization using estradiol levels, collected ova, and number of follicles

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094555
Author(s):  
Ivan Madrazo ◽  
Monserrat Fabiola Vélez ◽  
Josue Jonathan Hidalgo ◽  
Ginna Ortiz ◽  
Juan José Suárez ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Characteristic Curve ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Ovarian Hyperstimulation ◽  
Vitro Fertilization ◽  
American Society ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Severe Ohss

Objective Our objective was to determine whether estradiol (E2) levels (Day 3 and fold change to Day 10), antral follicle count (AFC), and number of ova collected could predict ovarian hyperstimulation syndrome (OHSS) and culdocentesis intervention. Methods We conducted a retrospective review of patient charts between January 2008 and December 2017. OHSS was defined using American Society for Reproductive Medicine criteria. Predictability was evaluated by measuring the area under the receiver operating characteristic curve (AUC). Results The cohort included 319 women (166 controls, 153 OHSS, of whom 54 had severe OHSS). The OHSS group had higher E2Day 3 (249 ± 177 vs. 150 ± 230 ng/L), E2FoldChange (32.2 ± 29.1 vs. 20.1 ± 23.8), AFC (18.2 ± 9.1 vs. 11.6 ± 8.3), and number of ova collected (21.1 ± 9.0 vs. 10.1 ± 6.5). E2Day 3 (AUC = 0.76, 95%CI: 0.71–0.82), E2FoldChange (AUC = 0.71, 95%CI: 0.65–0.77), AFC (AUC = 0.75, 95%CI: 0.70–0.81), and number of ova collected (AUC = 0.85, 95%CI: 0.81–0.89) were predictive for OHSS. All variables were predictive for culdocentesis intervention (E2Day 3: AUC = 0.63, 95%CI: 0.55–0.70; E2FoldChange: AUC = 0.63, 95%CI: 0.55–0.71; AFC: AUC = 0.74, 95%CI: 0.68–0.80; number of ova collected: AUC = 0.80, 95%CI: 0.75–0.85). Conclusions Day 3 E2 levels and number of ova collected predict patients who could develop OHSS and may require culdocentesis.

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