Talk:2015 Group Project 2

2015-10-13T03:42:31Z

Z5016784:

User:Z5016784

2015-10-09T01:02:55Z

Z5016784:

User:Z5016784

2015-09-25T03:00:52Z

Z5016784:

2015-09-11T03:25:29Z

Z5016784:

User:Z5016784

2015-09-11T03:25:18Z

Z5016784:

=Lab attendance=
--[[User:Z5016784|Z5016784]] ([[User talk:Z5016784|talk]]) 13:24, 11 September 2015 (AEST)

== Lab Assesment 1 ==

'''Influence of zona pellucida thickness of human embryos on clinical pregnancy outcome following in vitro fertilization treatment.'''

The success rate of IVF treatment is typically determined by clinical implantation and interplay of clinical and nonclinical variables such as endometrial receptivity, ovulation induction protocols, patient’s age, etiology of infertility and gamete to embryo quality. Embryo grading prior to the embryo transfer is a widely researched topic, however the current embryo grading systems don’t support enough research and new reliable parameters are needed to be found.
One of these parameters are predicting IVF outcomes based on the thickness of the Zona Pellucida during fertilisation. Two clinical evidence are in support of this parameter. Evidence has shown that the implantation rates of human embryos correlate with the Zona Pellucida thickness ranging from 10-29%. Also adverse influences of prolonged embryo culture conditions in vito, that are manifested in the thickening and hardening of the Zona Pellucida, is leading to failure of up to 75% of IVF embryo hatching due to micro assisted fertilization techniques such as zona thinning and hatching.
Throughout other research conducted, there has shown a strong influence of Zona Pellucida thickness of the transferred embryos on clinical IVF outcomes. However certain research has also shown that Zona Pellucida thickness can be a reliable indicator for predicting the success of in vito fertilisation. The test conducted by Anette Gabrielsen and others, was performed on 141 women to shown if there is any correlation between the thickness of the Zona Pellucida of embryos during intracytoplasmic sperm injection (ICSI) treatment cycles. The result was the thickness of the Zona Pellucida shows a strong correlation with the clinical outcomes following IVF treatment, Indicating Zona Pellucida thickness can be a reliable indicator for determining the outcome of IVF treatment

Anette Gabrielsen, Piyush R. Bhatnager, Karsten Petersen, Svend Lindenberg Influence of zona pellucida thickness of human embryos on clinical pregnancy outcome following in vitro fertilization treatment. J Assist Reprod Genet. 2000 Jul 17(6) 323-8.
[http://www.ncbi.nlm.nih.gov/pubmed/11042829]

'''Factors affecting fertilization: endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida.'''

Human spermatozoa must travel and reach an oocyte for fertilisation, many factors affect the amount or strength of the spermatozoa when released from ovulation. Of these factors, endometrial placental protein 14 is a glycoprotein that is secreted during the secretory phase endometrium and decidua in females. Researches have tested endometrial placental protein 14 to determine whether this glycoprotein reduces the capacity of spermatozoa to bind to the Zona Pellucida. Oehninger and Coddington performed an investigation by evaluated sperm samples from fertile men which were incubated with and with the endometrial placental protein 14.
A quick recap of the experimental method was the biologically active endometrial placental protein 14 was purified from human amniotic fluid via anion exchange. Once the separation has taken place, the spermatozoa was incubated for 30 minutes with and without the endometrial placental protein 14, then washed and used in a variety of assays. The ability of the binding of the Zona pelluicda were assayed in a 4 hour gamete incubation. Using a computerised sperm analyser, the acrosome reaction was determined.
This time consuming investigation concluded that endometrial placental protein 14 produces a fast, potent and dose dependent inhibition of binding of spermatozoa to the zona pellucida while not affecting other event such as the acrosomal reaction. The spermatozoa binding to the zona pellucida interaction has shown to be specific for this endometrial placental protein and has fundamental bearance to the process of fertilisation.

Oehninger S, Coddington CC, Hodgen GD, Seppala M. Factors affecting fertilization: endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida. Fertil Steril. 1995 Feb 63(2) 377-83. [http://www.ncbi.nlm.nih.gov/pubmed/7531163]

== Lab Assessment 2 ==

Xin Sun, Erik N. Meyers, Mark Lewandoski and Gail R. Martin, Targeted disruption of Fgf8 causes failure of cell migration in the gastrulating mouse embryo Genes Dev. 1999 13(14):1834–1846

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC316887/]Article
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC316887/figure/F1/] Image

== Lab Assessment 4 ==

<quiz display=simple>

{The paraxial mesoderm of the neural tube gives '''rise''' to which of the following?
|type="()"}
- Heart
+ Somites
- Body cavities
- Gastrointestinal Tract
- Urogenital System
||Yes, the Somites are derived from the paraxial mesoderm via the neural tube in early stage 7. The Urogenital System is developed in the intermediate mesoderm while the body cavities, GIT and heart are developed in the lateral plate mesoderm.

{In which '''week''' is the descent of the heart stopped by the enlargement of the liver?
|type="()"}
- Week 6
- Week 4
- Month 7
- Month 3-6
+ Week 7
||Due to the enlargement of the liver, the hearts descent is stopped after beginning in week 6

{Which of the following statements regarding the placenta is '''incorrect'''?
|type="()"}
- 3 types of placental classification include Haemochorial, Endotheliochorial and Epitheliochorial.
- The secondary stage of chorionic villi is developed in week 3.
+ Fetal surface contains cotyledons.
- Cord knotting is a type of placental cord abnormality.
- Trophoblast cells are the major source of placental hormones.
||The fetal surface does not contain cotyledons, they are present in the maternal side, The fetal side is covered with an amniotic membrane and is attached to chorionic plate

== Lab Assessment 5 ==

=Lab attendence=
--~~~~

'''What is the difference between gastroschisis and omphalocele? '''

'''Gastroschisis''' is a congenital birth defect which results in the anterior abdominal wall failing to completely close during early development. It occurs during the 4th week of pregnancy and happens 1 in every 5000 births with a 75% chance of occurring in the first born child [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147679/]. A small 2 inch opening can be seen right of the umbilical cord which results in the abdominal organs (Intestines, sometimes stomach and very rarely the liver) to protrude outside of the body lacking a peritoneal membrane. The hole is caused by a herniation of the abdominal viscera in the amniotic cavity. The external organs that are left floating in the amniotic fluid which can cause swelling, shortening of the intestines, less blood flow and even twisting of the bowel [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147679/].

In order to diagnosis an infant with Gastroschisis, physical examination is required. The infant will have problems with absorption and movement in the gut. Conducting a prenatal ultrasound, will successfully identify if there is any extra amniotic fluid. Treatment of Gastroschisis varies based on the amount of abdominal organs that are protruding out. If only a small amount is floating in the amniotic fluid, then a primary surgery repair is only required. However if there are large amounts of abdominal organs floating in the amniotic fluid, then staged repair is needed which lasts from 3 to 10 days. '''Omphalocele''' (exomphalos) is an abdominal wall defect similar to Gastroschisis, as it results in a hole with abdominal organs protruding out. However the difference in Omphalocele is that the umbilical cord is herniated and leaves a hole located at the belly button area with the abdominal organs spilling out but covered in a transparent sac [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1355659/].

Omphalocele occurs during week 11 of pregnancy and happens 1 in every 5300 babies. Causes of these abdominal wall defects are unknown, but research suggests that alcohol and tobacco use, certain medications and obesity lead to an increased chance of having one of these defects [http://www.ncbi.nlm.nih.gov/pubmed/19040938]. Omphalocele can be diagnoses by physical examination and a prenatal ultrasound. If an infant suffers from Omphalocele, then surgery can be used, however as the abdominal organs that protrude out are covered by a transparent sac, they are protected from unnecessary exposure to amniotic fluid. If surgery is undertaken, then a material is placed on the sac which results in the abdominal organs slowly pushing back into the abdominal cavity [http://www.ncbi.nlm.nih.gov/pubmed/19040938].

User:Z5016784

2015-09-11T03:24:50Z

Z5016784:

=Lab attendance=
--[[User:Z5016784|Z5016784]] ([[User talk:Z5016784|talk]]) 13:24, 11 September 2015 (AEST)

== Lab Assesment 1 ==

'''Influence of zona pellucida thickness of human embryos on clinical pregnancy outcome following in vitro fertilization treatment.'''

The success rate of IVF treatment is typically determined by clinical implantation and interplay of clinical and nonclinical variables such as endometrial receptivity, ovulation induction protocols, patient’s age, etiology of infertility and gamete to embryo quality. Embryo grading prior to the embryo transfer is a widely researched topic, however the current embryo grading systems don’t support enough research and new reliable parameters are needed to be found.
One of these parameters are predicting IVF outcomes based on the thickness of the Zona Pellucida during fertilisation. Two clinical evidence are in support of this parameter. Evidence has shown that the implantation rates of human embryos correlate with the Zona Pellucida thickness ranging from 10-29%. Also adverse influences of prolonged embryo culture conditions in vito, that are manifested in the thickening and hardening of the Zona Pellucida, is leading to failure of up to 75% of IVF embryo hatching due to micro assisted fertilization techniques such as zona thinning and hatching.
Throughout other research conducted, there has shown a strong influence of Zona Pellucida thickness of the transferred embryos on clinical IVF outcomes. However certain research has also shown that Zona Pellucida thickness can be a reliable indicator for predicting the success of in vito fertilisation. The test conducted by Anette Gabrielsen and others, was performed on 141 women to shown if there is any correlation between the thickness of the Zona Pellucida of embryos during intracytoplasmic sperm injection (ICSI) treatment cycles. The result was the thickness of the Zona Pellucida shows a strong correlation with the clinical outcomes following IVF treatment, Indicating Zona Pellucida thickness can be a reliable indicator for determining the outcome of IVF treatment

Anette Gabrielsen, Piyush R. Bhatnager, Karsten Petersen, Svend Lindenberg Influence of zona pellucida thickness of human embryos on clinical pregnancy outcome following in vitro fertilization treatment. J Assist Reprod Genet. 2000 Jul 17(6) 323-8.
[http://www.ncbi.nlm.nih.gov/pubmed/11042829]

'''Factors affecting fertilization: endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida.'''

Human spermatozoa must travel and reach an oocyte for fertilisation, many factors affect the amount or strength of the spermatozoa when released from ovulation. Of these factors, endometrial placental protein 14 is a glycoprotein that is secreted during the secretory phase endometrium and decidua in females. Researches have tested endometrial placental protein 14 to determine whether this glycoprotein reduces the capacity of spermatozoa to bind to the Zona Pellucida. Oehninger and Coddington performed an investigation by evaluated sperm samples from fertile men which were incubated with and with the endometrial placental protein 14.
A quick recap of the experimental method was the biologically active endometrial placental protein 14 was purified from human amniotic fluid via anion exchange. Once the separation has taken place, the spermatozoa was incubated for 30 minutes with and without the endometrial placental protein 14, then washed and used in a variety of assays. The ability of the binding of the Zona pelluicda were assayed in a 4 hour gamete incubation. Using a computerised sperm analyser, the acrosome reaction was determined.
This time consuming investigation concluded that endometrial placental protein 14 produces a fast, potent and dose dependent inhibition of binding of spermatozoa to the zona pellucida while not affecting other event such as the acrosomal reaction. The spermatozoa binding to the zona pellucida interaction has shown to be specific for this endometrial placental protein and has fundamental bearance to the process of fertilisation.

Oehninger S, Coddington CC, Hodgen GD, Seppala M. Factors affecting fertilization: endometrial placental protein 14 reduces the capacity of human spermatozoa to bind to the human zona pellucida. Fertil Steril. 1995 Feb 63(2) 377-83. [http://www.ncbi.nlm.nih.gov/pubmed/7531163]

== Lab Assessment 2 ==

Xin Sun, Erik N. Meyers, Mark Lewandoski and Gail R. Martin, Targeted disruption of Fgf8 causes failure of cell migration in the gastrulating mouse embryo Genes Dev. 1999 13(14):1834–1846

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC316887/]Article
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC316887/figure/F1/] Image

== Lab Assessment 4 ==

<quiz display=simple>

{The paraxial mesoderm of the neural tube gives '''rise''' to which of the following?
|type="()"}
- Heart
+ Somites
- Body cavities
- Gastrointestinal Tract
- Urogenital System
||Yes, the Somites are derived from the paraxial mesoderm via the neural tube in early stage 7. The Urogenital System is developed in the intermediate mesoderm while the body cavities, GIT and heart are developed in the lateral plate mesoderm.

{In which '''week''' is the descent of the heart stopped by the enlargement of the liver?
|type="()"}
- Week 6
- Week 4
- Month 7
- Month 3-6
+ Week 7
||Due to the enlargement of the liver, the hearts descent is stopped after beginning in week 6

{Which of the following statements regarding the placenta is '''incorrect'''?
|type="()"}
- 3 types of placental classification include Haemochorial, Endotheliochorial and Epitheliochorial.
- The secondary stage of chorionic villi is developed in week 3.
+ Fetal surface contains cotyledons.
- Cord knotting is a type of placental cord abnormality.
- Trophoblast cells are the major source of placental hormones.
||The fetal surface does not contain cotyledons, they are present in the maternal side, The fetal side is covered with an amniotic membrane and is attached to chorionic plate

=Lab attendance=
--~~~~

== Lab Assessment 5 ==

'''What is the difference between gastroschisis and omphalocele? '''

'''Gastroschisis''' is a congenital birth defect which results in the anterior abdominal wall failing to completely close during early development. It occurs during the 4th week of pregnancy and happens 1 in every 5000 births with a 75% chance of occurring in the first born child [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147679/]. A small 2 inch opening can be seen right of the umbilical cord which results in the abdominal organs (Intestines, sometimes stomach and very rarely the liver) to protrude outside of the body lacking a peritoneal membrane. The hole is caused by a herniation of the abdominal viscera in the amniotic cavity. The external organs that are left floating in the amniotic fluid which can cause swelling, shortening of the intestines, less blood flow and even twisting of the bowel [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147679/].

In order to diagnosis an infant with Gastroschisis, physical examination is required. The infant will have problems with absorption and movement in the gut. Conducting a prenatal ultrasound, will successfully identify if there is any extra amniotic fluid. Treatment of Gastroschisis varies based on the amount of abdominal organs that are protruding out. If only a small amount is floating in the amniotic fluid, then a primary surgery repair is only required. However if there are large amounts of abdominal organs floating in the amniotic fluid, then staged repair is needed which lasts from 3 to 10 days. '''Omphalocele''' (exomphalos) is an abdominal wall defect similar to Gastroschisis, as it results in a hole with abdominal organs protruding out. However the difference in Omphalocele is that the umbilical cord is herniated and leaves a hole located at the belly button area with the abdominal organs spilling out but covered in a transparent sac [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1355659/].

Omphalocele occurs during week 11 of pregnancy and happens 1 in every 5300 babies. Causes of these abdominal wall defects are unknown, but research suggests that alcohol and tobacco use, certain medications and obesity lead to an increased chance of having one of these defects [http://www.ncbi.nlm.nih.gov/pubmed/19040938]. Omphalocele can be diagnoses by physical examination and a prenatal ultrasound. If an infant suffers from Omphalocele, then surgery can be used, however as the abdominal organs that protrude out are covered by a transparent sac, they are protected from unnecessary exposure to amniotic fluid. If surgery is undertaken, then a material is placed on the sac which results in the abdominal organs slowly pushing back into the abdominal cavity [http://www.ncbi.nlm.nih.gov/pubmed/19040938].

2015-09-11T01:32:22Z

Z5016784:

{{ANAT2341Project2015header}}

==Ovarian Hyper-stimulation Syndrome (OHSS)==

Ovarian Hyper stimulation Syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology, in which women take medications to stimulate oocyte growth. It is generally identified by cystic enlargements of the ovaries a fluid shift from the intravascular to the third space due to the increased capillary permeability and ovarian neoangiogenesis <ref name="PMID22065820"><pubmed>22065820</pubmed></ref>. It is an occurrence which is dependent on the administration of the Human Chorionic Gonadotropin (hCG). This wikipage aims to provide clear information on the epidemiology, causatives of OHSS, symptoms as well as treatment and prevention methods.

==Epidemiology==

<pubmed>12498425</pubmed>

Ovarian Hyper-Stimulation Syndrome (OHSS) rarely occurs sporadically, and if it does, it is usually the result of an underlying genetic problem. The majority of OHSS is due to the ovaries being stimulated to mature and release an abundance of oocytes, in response to hormones Human Chorionic Gonadotropin (hCG) and Follicle Stimulating hormone (FSH), during IVF. Rarely, Clomifene Citrate therapy can cause OHSS.'''[OHSS Wiki]'''

==Causative Agents==

--[[User:Z3374116|Z3374116]] ([[User talk:Z3374116|talk]]) 23:39, 27 August 2015 (AEST) I've begun collating and writing information on word for now regarding this Subheading

<pubmed>19573285</pubmed>

<pubmed>26190539</pubmed>

==Symptoms==

OHSS is classified based on a criteria from mild, moderate and severe:

'''Mild Symptoms'''- abdominal bloating, minimal weight gain, nausea, diarrhoea and a feeling of fullness.

'''Moderate Symptoms'''- Substantial weight gain (on average 2 or more pounds a day), increased abdominal girth, darkend urine and excessive thirst in addition to the mild symptoms.

'''Severe Symptoms'''- In addition to the symptoms associated with Mild and Moderate OHSS, in severe OHSS, you see shortness of breath, calf and chest pains and pleural effusion '''[OHSS Wiki]'''

'''Classifications of Ovarian Hyper-stimulation Syndrome'''<ref name="PMID22065820"><pubmed>22065820</pubmed></ref>
{| class="wikitable" style="text-align:center
|-
! scope="col" width="70px"| '''Classification'''
! scope="col" width="650px"| '''Symptoms'''
|-
|style="text-align:center; background: #CCEEEE;"| '''Mild'''
|style="height: 60px; background: #CCEEEE;"| '''Grade 1''' - Abdominal distention and discomfort
'''Grade 2''' - Abdominal distention, discomfort with nausea, vomiting and/or diarrhea and ovarian enlargement from 5~12cm
|-
|style="text-align:center; background: #EEEEEE;"| '''Moderate'''
|style="height: 60px; background: #EEEEEE;"| '''Grade 3''' - All features of Mild OHSS with ultrasonographic evidence of ascites
|-
|style="text-align:center; background: #CCEEEE;"| '''Severe'''
|style="height: 60px; background: #CCEEEE;"| '''Grade 4''' - All features of Moderate OHSS with the addition of clinical evidence of ascites and breathing difficulties present
'''Grade 5''' - All of the above symptoms along with a change in the blood volume, increased blood viscosity due to coagulation and diminished renal function
|}

PMID 24996451
<ref><pubmed>24996451</pubmed></ref>

PMID 23378404
<ref><pubmed>23378404</pubmed></ref>

==Diagnosis==

[1]Initially women with OHSS will present with abdominal bloating, as a result of fluid in the peritoneal cavity and an increase in ovary size. Whilst symptoms can occur as soon as 24 hours post hCG administration, they are usually seen in women 7-10 days post administration. When women present with severe OHSS they are often dehydrated, due to increased vascular permeability, and have hemoconcentration. The above results in a decrease in intravascular volume, leading to oligouria.

A key diagnostic tool for clinicians regarding women who are taking gonadotropins is to identify if they are at an increased risk of developing OHSS. Some risk factors include woman aged less than 30, women who have polycystic ovaries, woman with a previous history of OHSS and women who have greater than 20 oocytes retrieved. After a history of the patient is taken, the next step is to perform a physical exam on the patient. Women who present with abdominal bloating will produce a shifting dullness upon abdominal percussion. If the clinician further suspects a women of having OHSS, an ultrasound can be done.The intraperitoneal fluid is best imaged via vaginal ultrasound due to the enlarged ovaries making it difficult to image the pelvis using transabdominal ultrasound. <ref name="PMID22416285"><pubmed>22416285</pubmed></ref>

==Pathophysiology==

The definition of Ovarian Stimulation is enlarged ovaries with many luteinized cysts, that can present with secondary complications. What distinguishes Ovarian Stimulations from OHSS is the presence of vascular hyper-permeability that results in fluids being redirected elsewhere in the body.

The key process to OHSS appears to be caused by Vascular Endothelial Growth Factor (VEGF), that is released along with other cytokines, estrogen and progesterone due to the ovary undergoing luteinization as a result of stimulation by hCG. VEGF increases vascular permeability and as a result the capillaries become more "leaky" to the fluids in them. These fluids can then escape the capillaries and accumulate in the pleural and abdominal cavities as ascites. The women then becomes hypovolemic and is at an increased risk of circulatory, renal and respiratory issues such as arterial thromboembolism due to the thickening of the blood. Note, the blood is thickened as fluid is leaving the capillaries, leaving behind red blood cells and other cellular components of the blood '''[OHSS Wiki]'''.

==Complications==

Ovarian torsion or rupture, renal insufficiency and thrombophlebitis can all complicate OHSS. If a pregnancy occurs, symptoms may persist longer than the usual 1 to 2 weeks and become more severe, however, even with severe OHSS, they do not extend past the first trimester '''[OHSS Wiki]'''.

1-2% of women who suffer from ovarian stimulation develop a severe form of OHSS. Complications from severe OHSS include:

- Fluid collection in the abdomen
- Electrolyte disturbances (sodium and potassium)
- Blood clots in large vessels (most commonly the legs)
- Kidney failure
- Ovary twisting
- Rupture of a cyst in an ovary
- Breathing problems
- Pregnancy loss from miscarriage or termination
- Rarely, death

==Tests and Diagnosis==

'''I think we need to reassess the necessity of this section
'''

A Physical Exam, A doctor will note any abdominal pain, increase in waist size or any weight gain.

An Ultrasound, an ultrasound will show ovaries bigger then normal because they are filled with large fluid-filled cysts where follicles developed. A vaginal ultrasound can be used during treatment with fertility drugs.

A Blood Test, Certain blood tests show a change in blood concentration, it may also show wheather your kidney function is impaired by OHSS.

==Treatment==

Mild to Moderate OHSS
Mild OHSS resolves on its own, However Moderate OHSS may include treatments such as:

Anti-nausea medication and prescription painkillers

Regular physical examinations and ultrasounds

Daily weigh-ins and waist measurements

Measuring the amount of urine produced each day

Blood tests for monitoring dehydration and electrolyte imbalance

Maintaining a high balance of fluids

Draining excess abdominal fluid by inserting a needle in the abdominal cavity

Wearing support stockings which help prevent blood clots

Severe OHSS

Severe OHSS requires hospital care for monitoring levels and aggressive treatment such as intravenous fluids. Some medications may be given such as:

Cabergoline lessens OHSS symptoms

Gn-RH antagonist suppresses ovarian activity

If there are serious complications then additional treatments are required:

Surgery for a ruptured ovarian cyst

Intensive care for the liver or lung complications

Anticoagulant medications decrease the risk of blood clots in your legs

- If at risk OHSS, alternates include using a GnRH antagonist instead of hCG however its effects on pregnancy rates are questionable (see OHSS Wiki).

==Prevention==

<pubmed>26246873</pubmed>

--[[User:Z3372824|Z3372824]] ([[User talk:Z3372824|talk]]) 09:09, 28 August 2015 (AEST) So this is quite a rough draft as im trying to get the ideas down. I'm thinking of changing the format of some subsections to bullet points. The risk factor section can arguably have a subheading of its own, but it is crucial in informing the subsequent prevention strategy to be undertaken.

The three key pathways by which the incidence of OHSS has been curtailed involve identifying risk factors to predict OHSS development, modifying treatment regimes on the basis of the identified risk factors and intervention to prevent progression to OHSS once the patient has undergone Controlled Ovarian Stimulation.

1) Risk factors

Primary: Preexisting factors likely to exacerbate the ovarian stimulation response. Include: young age, low body weight, history of elevated response to gonadotropins, Polycystic Ovary Syndrome (PCOS), isolated PCOS characteristic or a previous history of OHSS. Anti-Mullerian Hormone markers (AMH) are a newly developed predictive tool with a sensitivity of 90.5% and specificity of 81.3%. Ultrasonographic markers including antral follicle count
PMID 26074966

Secondary:

2) Prevention

Primary:
a) Gonadotropins: reduce duration, reduce dose, avoid GnRH Agonists PMID 23873146

b) Use Metformin Therapy

c) Target Unifollicular Ovulation

d) Avoid hCG

e) In Vitro Maturation

Secondary:
a) Reduce hCG dose

b) Coasting

c) Cryopreservation of Embryos

d) Cancel Cycle

e) Use alternative Agents

PMID 20416867

==Glossary==

'''Ascites'''- An accumulation of fluid in the peritoneal cavity with resultant abdominal swelling

'''Cabergoline''' - A dopamine receptor agonist used to treat hormone imbalance.

'''GnRH antagonist''' - Gonadotropin Releasing Hormone - A class of compounds that are similar in terms of the structure of natural Gonadotropin Releasing Hormone but has a antagonistic effect.

'''hCG'''- Human Chorionic Gonadotropin

'''Hemoconcentration'''- An increase in the concentration of circulating red blood cells in response to a decrease in blood plasma volume

'''Hypovolemic'''- A decrease in circulating blood volume

'''Intravenous fluids''' - Is the infusion of liquid substances directly into a vein.

'''IVF'''- In-vitro Fertilization

'''OHSS'''= Ovarian Hyper-stimulation Syndrome

'''Oliguria'''- Decreased urine output/small amounts of urine produced

==References==