Chapter 36 - Ultrasonography in the prediction and management of ovarian hyperstimulation syndrome

Summary

Ovarian hyperstimulation syndrome (OHSS) is characterized by bilateral cystic ovarian enlargement and third-space fluid shift resulting in ascites and pleural effusion. The cornerstone of successful prevention of ovarian hyperstimulation syndrome (OHSS) is accurate prediction. Prediction of OHSS depends on identification of factors prior to ovarian stimulation, such as the history of previous OHSS or polycystic ovary syndrome. The diagnosis of polycystic ovaries at ultrasound examination (the necklace sign) is crucial in the prediction of OHSS. Ultrasound is widely used for monitoring follicular development in assisted conception. Patients with severe OHSS (grade C) are treated in the hospital, while patients with grades A and B may be treated in the in vitro fertilization (IVF) unit or the hospital depending on the presence or absence of complications. Rizk and Aboulghar recommended that aspiration of ascitic fluid be performed transvaginally or transabdominally under ultrasonographic guidance in the presence of tense ascites.