A case of severe ovarian hyperstimulation syndrome

First case report of serous otitis media as a complication of severe ovarian hyperstimulation syndrome: Case report and literature review

Ovarian hyperstimulation syndrome (OHSS) may be a severe complication of controlled ovarian hyperstimulation during assisted reproductive technology. During OHSS, fluid shifts from the intravascular space to the third-space compartments as the result of an increase in capillary permeability. This can cause fluid accumulation in peritoneal as well as thoracic cavities. The patient presented with symptoms of severe OHSS (bilateral hydrothorax and pulmonary effusion), requiring bilateral ultrasound-guided paracentesis and bilateral thoracentesis during her Emergency Room visits and hospitalization. Due to distant effects from the increased capillary permeability, the patient presented fluid in the middle ear, which led to the development of serous otitis media 12 days after egg retrieval. This was resolved 2-3 weeks later after being treated with antihistamines and antibiotics given by her Ear, Nose, and Throat doctor. OHSS risk may be reduced by continuous monitoring of patients undergoing ovulation induction, using an appropriate gonadotropin dosage, and using additional agents known to decrease its risk. If OHSS still occurs, symptomatic treatment and a multidisciplinary team of professionals may be needed to prevent fluid build-up complications. In contrast to many published articles about OHSS and its complications, this is the first case report of a patient presenting serous otitis media as a complication of severe OHSS.

Ovarian hyperstimulation syndrome. A new look at an old problem

To analyze the management of severe ovarian hyperstimulation syndrome based on aspects of its etiology and pathogenesis a systematic review of the literature was done. An evaluation of clinical trials, meta-analysis, case-reports and reviews assessing the management of different conditions related to ovarian hyperstimulation syndrome was made using the following data sources: MEDLINE Pubmed (from 1966 to July 2018) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2018). The role of intra-abdominal hypertension in the development of the severe forms of ovarian hyperstimulation syndrome and its complicated outcomes was assessed. The pathophysiology and clinic of intra-abdominal hypertension syndrome are almost identical to moderate and severe forms of ovarian hyperstimulation syndrome and associated organ dysfunction. The classic triad (respiratory disorders, reduction in venous return, and restriction of perfusion in internal organs) is present in severe ovarian hyperstimulation syndrome as well as in intra-abdominal hypertension syndrome. This review provides recommendations for the management of ovarian hyperstimulation syndrome and insight into the different medical complaints of this syndrome. The principles of therapy for intra-abdominal hypertension syndrome might be considered in the treatment of severe forms of ovarian hyperstimulation syndrome.