OVARIAN HYPERSTIMULATION SYNDROME

SYMPTOMS

The symptoms of Ovarian hyperstimulation syndrome can vary in severity and may range from mild discomfort to life-threatening complications. Common signs and symptoms of OHSS may include:

• Abdominal bloating: Sensation of abdominal distention, bloating, or discomfort due to enlarged ovaries and accumulation of fluid in the abdominal cavity (ascites).
• Ovarian enlargement: Palpable enlargement of the ovaries, which may be tender or painful on abdominal examination.
• Nausea and vomiting: Nausea, vomiting, or gastrointestinal symptoms may occur, particularly in moderate to severe cases of OHSS.
• Fluid retention: Edema or swelling of the extremities, hands, or feet due to fluid shifts and fluid retention in body tissues.
• Weight gain: Rapid weight gain or fluid accumulation may occur, often exceeding 2-3 kilograms within a few days.
• Shortness of breath: Dyspnea (shortness of breath) or difficulty breathing may occur due to pleural effusion (accumulation of fluid around the lungs) or respiratory compromise.
• Decreased urine output: Oliguria (decreased urine output) or signs of renal impairment may develop in severe cases of OHSS due to intravascular volume depletion and hemoconcentration.
• Pelvic discomfort: Pelvic or lower abdominal pain, discomfort, or pressure may be present, particularly in cases of ovarian enlargement or ovarian torsion (twisting of the ovary).

DIAGNOSIS

Diagnosing Ovarian hyperstimulation syndrome typically involves a combination of clinical assessment, laboratory tests, and imaging studies to evaluate for signs of ovarian hyperstimulation and assess the severity of symptoms. Diagnostic steps may include:

• Physical examination: A thorough physical examination, including abdominal palpation and assessment of vital signs, is performed to evaluate for signs of ovarian enlargement, fluid accumulation, or complications of OHSS.
• Laboratory tests: Blood tests, including estradiol levels, hematocrit, electrolytes, renal function tests, liver function tests, and coagulation studies, may be conducted to detect hormonal imbalances, electrolyte abnormalities, and renal or hepatic dysfunction.
• Imaging studies: Transvaginal or abdominal ultrasounds can evaluate ovarian size, morphology, and fluid collections in the abdominal cavity, aiding in diagnosing ovarian torsion or other complications of OHSS, including ascites.

TREATMENT

Management of Ovarian hyperstimulation syndrome focuses on supportive care, symptom management, and prevention of complications to minimize risks and optimize outcomes for affected individuals. Treatment options may include:

• Fluid and electrolyte management: Oral or intravenous fluids, electrolyte replacement, and close monitoring of fluid balance are essential in managing dehydration, electrolyte imbalances, and intravascular volume depletion associated with OHSS.
• Pain relief: Analgesic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioid analgesics may be prescribed to relieve abdominal discomfort, pain, or ovarian tenderness.
• Paracentesis: Therapeutic paracentesis or drainage of ascitic fluid may be performed to alleviate symptoms of abdominal distention, discomfort, or respiratory compromise in cases of severe or refractory ascites.