QuestionSBA
QuestionChoice
Ectopic pregnancy is unlikely to occur in the context of fertility treatments, as woman are usually advised to abstain from intercourse during ovarian stimulation. Ectopic pregnancy often presents with unilateral pain, associated with haemodynamic instability. It would be unusual to present with peripheral oedema and pleural effusion.
50000
d
Ectopic pregnancy
QuestionChoice
Whilst ovarian torsion is a likely diagnosis, associated with ovarian stimulation, it typically presents with unilateral pain which is sudden in onset and not usually associated with peripheral oedema or pleural effusion.
50001
e
Ovarian torsion
QuestionChoice
Whilst oocyte retrieval carries a risk of pelvic infection, this woman is apyrexial and does not complain of any pelvic pain or unusual vaginal discharge.
49998
b
Pelvic infection
QuestionChoice
Whilst intraabdominal haemorrhage may present with abdominal discomfort and tachycardia, this would be an unusual complication of oocyte retrieval. In addition, this is unlikely to cause peripheral oedema or pleural effusion.
49999
c
Intraabdominal haemorrhage
QuestionChoice
Ovarian hyperstimulation syndrome (OHSS) is a clinical diagnosis based on a typical history and examination findings. OHSS typically occurs following treatment with follicle-stimulating hormone (FSH), which promotes follicular maturation during fertility treatments. OHSS is associated with an excessive ovarian response, leading to fluid shift into the extravascular spaces, hence causing peripheral oedema, ascites and pleural effusion. The management is typically supportive.
49997
a
Ovarian hyperstimulation syndrome
Concept
Chapter
# Summary


Ovarian hyperstimulation syndrome (OHSS) is a potentially severe complication of iatrogenic induction of ovulation, often associated with in-vitro fertilization (IVF) procedures. It is characterized by an exaggerated response to hormonal therapies leading to the excessive production of oestrogen, progesterone, and local cytokines. Key signs and symptoms include bloating, abdominal discomfort, and fluid retention, which can manifest as oedema, pleural effusions, ascites, and weight gain. Investigations often involve routine blood tests to assess haemoconcentration and organ dysfunction, and a chest X-ray to detect pleural effusion. Management is primarily supportive, ranging from simple analgesia to intensive care unit (ICU) admission, depending on the severity of the condition.


# Definition


Ovarian hyperstimulation syndrome (OHSS) is a complication arising from iatrogenic induction of ovulation, characterized by an exaggerated response to hormonal therapies used in procedures such as in-vitro fertilization (IVF).



# Aetiology


OHSS occurs due to an excessive response to hormones used in IVF, leading to multiple follicles maturing and enlarging. Upon ovulation, each of these follicles transforms into a corpus luteum, resulting in an overproduction of oestrogen, progesterone, and local cytokines, especially vascular endothelial growth factor (VEGF).


# Signs and Symptoms


The overstimulation of the ovaries can cause significant enlargement, leading to pressure on surrounding structures. This can result in the following symptoms:

- Bloating
- Abdominal discomfort

VEGF can cause blood vessels to leak, leading to fluid retention manifesting as:

- Oedema
- Pleural effusions
- Ascites
- Weight gain

# Investigations

The following investigations are often conducted to diagnose OHSS and assess the severity:

- Routine blood tests: These are used to evaluate haemoconcentration and detect potential organ dysfunction.
- Chest X-ray: This is performed to identify the presence of pleural effusion.

# Management

The management of OHSS is largely supportive and tailored according to the severity of the condition. It can range from administration of simple analgesia to manage discomfort, to admission to the intensive care unit (ICU) for more severe cases. Ongoing monitoring and supportive care are essential to prevent complications and promote recovery.
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Ovarian hyperstimulation syndrome
Topic
38
Obstetrics
10036
A 45-year-old woman attends accident and emergency feeling generally unwell. She is undergoing fertility treatment and has just undergone oocyte retrieval the day prior, which yielded 14 oocytes.

On examination, her observations are as follows:

- Temperature: 37.6°C
- Respiratory rate: 25 breaths per minute
- Heart rate: 110 beats per minute
- Blood pressure: 115/62mmHg
- Oxygen saturations: 97%

Her abdomen is distended, tense and uncomfortable. She has peripheral oedema evident in her feet. Her lungs are clear; however the bases of both lungs are dull to percussion.

What is the most likely diagnosis?
a