2015 Group Project 2

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-Simulation Syndrome is...

Epidemiology

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Causative Agents

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

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Symptoms and 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 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.

Once a women has been diagnosed as having OHSS, they are classified based on a criteria from mild, moderate and severe.

Classifications of Ovarian Hyper-stimulation Syndrome

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

PMID 23378404

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

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--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.