Gynecology And Obstetrics-

Ovarian hyperstimulation syndrome

introduction

Ovarian hyperstimulation syndrome is a potentially life threatening condition that can occur after medical intervention.

It is an overstimulation of the ovaries, which are located on the ovaries. This overstimulation occurs as a result of a hormonal stimulus, which can also be called a trigger. Ovarian hyperstimulation syndrome arises in some women as a result of fertility treatment for reasons that are still partly unexplained. While mild forms of ovarian hyperstimulation syndrome can be treated on an outpatient basis, severe forms of the disease must always be treated as an inpatient in hospital.

causes

Ovarian hyperstimulation syndrome occurs as a result of hormonal overstimulation of the ovaries, or more precisely the follicles.

This hormonal stimulation of the follicles is deliberately carried out as part of fertility treatment for women with an unfulfilled desire to have children. The established method, in which the hormone HCG is given, leads to ovulation. The triggering of ovulation is used, among other things, in artificial insemination.

For unexplained reasons, the administration of HCG can lead to a systemically increased permeability of the vessels. The consequence of this increased permeability is a sometimes massive displacement of liquid out of the vessels. This fluid displacement can lead to serious consequences, such as water retention in the abdomen and lungs. The most important risk factor for the development of ovarian hyperstimulation syndrome is polycystic ovary syndrome, or PCO syndrome for short. This metabolic disorder, which is associated with cysts on the ovaries, can tend to overstimulate after hormonal treatment with HCG.

Degrees of severity

The severity of the ovarian hyperstimulation syndrome is determined based on the symptoms and the results of various examinations.

There are generally three degrees of severity according to the classification of the World Health Organization. In stage I, the mildest form, there is a slight feeling of fullness and an otherwise only slightly restricted general condition. In the ultrasound examination, ovarian cysts up to 5 cm in size and a maximum enlargement of the ovaries up to 12 cm are found.

Stage II of the ovarian hyperstimulation syndrome is characterized by more severe symptoms such as nausea and vomiting, as well as a distended stomach. The general condition is now clearly restricted. At this stage, too, the ovaries are enlarged to a maximum size of 12 cm.

Stage III is a serious clinical picture that can sometimes be life-threatening. It is accompanied by an ovarian enlargement of over 12 cm, shortness of breath due to water retention in the lungs, a massively tense abdominal wall and thromboembolism.

Concomitant symptoms

In the run-up to fertility treatment with HCG, information about possible symptoms of ovarian hyperstimulation syndrome is always provided.

An incipient hyperstimulation syndrome can be recognized by symptoms such as nausea, a feeling of fullness or even vomiting. Tension of the abdominal wall or a feeling of "bloating" is also very typical for the syndrome. Such symptoms should lead to the attending gynecologist after HCG administration.

A distinction is made between an early syndrome, which arises immediately after the HCG administration, and a late hyperstimulation syndrome, which occurs after about 10 to 20 days. Therefore, one should take serious complaints that arise very late. Other symptoms that can be signs of ovarian hyperstimulation syndrome include shortness of breath, chest tightness, pain in arms or legs, and fatigue.

therapy

The ovarian hyperstimulation syndrome cannot be treated causally, only symptomatically.

Outpatient treatment can be provided for mild forms of ovarian hyperstimulation syndrome. This means that the affected woman does not have to be admitted to hospital. The treatment consists in particular of physical rest and fluid balance. Those affected must ensure that they drink a large amount and eat a diet that is as rich in protein as possible. This should counteract the loss of fluid through the permeable vessel walls. Furthermore, it makes sense to wear anti-thrombosis stockings and, if necessary, to receive heparin injections, especially when there is little movement and additional risk factors for thrombosis. Even with mild forms of ovarian hyperstimulation syndrome, check-ups must always be made with the treating gynecologist so that if the symptoms worsen, inpatient treatment can still be carried out.

In the case of severe forms of the syndrome, inpatient treatment is always carried out with daily checks of the blood count, coagulation values, weight and blood salts (electrolytes). Therapy with heparin, which partially inhibits blood clotting, is also important. This is necessary in order to reduce the high risk of thrombosis in ovarian hyperstimulation syndrome. Furthermore, accumulations of fluid in the abdomen (ascites) or in the lung membrane (pleural effusion) can be punctured and drained. This can alleviate symptoms such as tightness in the abdominal wall and shortness of breath. In consideration of the side effects or undesirable effects, fluids or a protein called albumin may be administered via the vein. This therapy aims to compensate for the loss of fluid in the vessels.

diagnosis

The diagnosis of ovarian hyperstimulation syndrome is made on the basis of clinical appearance and clinical examination.

Ovarian hyperstimulation syndrome can be divided into three degrees of severity, which are determined based on the symptoms and the test results. The diagnosis is made if, after hormonal treatment with HCG, symptoms such as bloating, vomiting and bloating of the abdomen, as well as ovarian enlargement are noticed on ultrasound. In advanced stages, further complications can be diagnosed, such as blood clots (thromboembolism) in various vessels and water retention in the abdomen or the lungs.

Duration and forecast

The duration of ovarian hyperstimulation syndrome depends on the severity. Mild ovarian hyperstimulation syndrome can resolve within a few days. The harmless clinical picture does not cause long-term damage and heals without consequences.

In the advanced stages of the syndrome, however, life-threatening situations can arise, which is why close monitoring must always be carried out under inpatient conditions. The time until healing can be between one and several weeks.