2015 Group Project 2: Difference between revisions

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==Symptoms and Diagnosis==
==Symptoms==


[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.
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.


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 woman. Women who present with abdominal bloating will produce a shifting dullness upon abdominal percussion. If the clinician further suspects a women of having OHSS, a ultrasound can be done.The intraperitoneal fluid is best images via vaginal ultrasound due to the enlarged ovaries making it difficult to image the pelvis using transabdominal ultrasound.  
'''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.  


Once a women has been diagnosed as having OHSS, they are classified based on a criteria from mild, moderate and severe. <ref name="PMID22416285"><pubmed>22416285</pubmed></ref>
'''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]'''


<span style="font-size:100%">'''Classifications of Ovarian Hyper-stimulation Syndrome'''</span><ref name="PMID22065820"><pubmed>22065820</pubmed></ref>
<span style="font-size:100%">'''Classifications of Ovarian Hyper-stimulation Syndrome'''</span><ref name="PMID22065820"><pubmed>22065820</pubmed></ref>
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PMID 24996451
PMID 24996451
<ref><pubmed>24996451</pubmed></ref>
<ref><pubmed>24996451</pubmed></ref>
This article is good because it goes into OHSS well in the background and it speaks about predictive factors for OHSS and how they affect recovery. This article ties in well with treatment and recovery and touches on the protocol used for Ovarian Hyper-Stimulation.


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


This article is good because it speaks generlly and specifically about OHSS and ties in well with the complications of the syndrome e.g. thromboembolism, which can also be used as a diagnostic factor depending on when the women present to a health care professional.  
==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==
==Pathophysiology==

Revision as of 22:47, 1 September 2015

2015 Student Projects 
2015 Projects: Three Person Embryos | Ovarian Hyper-stimulation Syndrome | Polycystic Ovarian Syndrome | Male Infertility | Oncofertility | Preimplantation Genetic Diagnosis | Students
2015 Group Project Topic - Assisted Reproductive Technology
This page is an undergraduate science embryology student and may contain inaccuracies in either description or acknowledgements.

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 [1]. 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

--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[1]

Classification Symptoms
Mild Grade 1 - Abdominal distention and discomfort

Grade 2 - Abdominal distention, discomfort with nausea, vomiting and/or diarrhea and ovarian enlargement from 5~12cm

Moderate Grade 3 - All features of Mild OHSS with ultrasonographic evidence of ascites
Severe 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 [2]

PMID 23378404 [3]

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. [4]

Pathophysiology

Complications

Tests and Diagnosis

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

Prevention

<pubmed>26246873</pubmed>

--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

hCG- Human Chorionic Gonadotropin

Hemoconcentration-

OHSS= Ovarian Hyper-stimulation Syndrome

Oligouria-

Cabergoline - Used to treat hormone imbalance.

Gn-RH 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.

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

IVF- In-vitro Fertilization

References

  1. 1.0 1.1 <pubmed>22065820</pubmed>
  2. <pubmed>24996451</pubmed>
  3. <pubmed>23378404</pubmed>
  4. <pubmed>22416285</pubmed>