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Review
. 2024 Aug 28;14(9):915.
doi: 10.3390/jpm14090915.

Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications

Giuseppe Gullo  1 , Gaspare Cucinella  1 , Vukasin Stojanovic  2 , Mirjana Stojkovic  3 , Carmine Bruno  4   5 , Adriana Vita Streva  1 , Alessandra Lopez  1 , Antonio Perino  1 , Susanna Marinelli  6
Affiliations
Review

Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications

Giuseppe Gullo et al. J Pers Med. .

Abstract

Background: Infertility is a highly meaningful issue with potentially life-changing consequences, and its incidence has been growing worldwide. Assisted reproductive technology (ART) has made giant strides in terms of treating many infertility conditions, despite the risk of developing ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening complication.

Methods: This narrative review draws upon scientific articles found in the PubMed database. The search spanned the 1990-2024 period. Search strings used included "OHSS" or "ovarian hyperstimulation" and "IVF" and "GnRH" and "hCG"; 1098 results were retrieved and were ultimately narrowed down to 111 suitable sources, i.e., relevant articles dealing with the condition's underlying dynamics, management pathways, and evidence-based criteria and guidelines, crucial both from a clinical perspective and from the standpoint of medicolegal tenability.

Results: The following features constitute OHSS risk factors: young age, low body weight, and polycystic ovarian syndrome (PCOS), among others. GnRH antagonist can substantially lower the risk of severe OHSS, compared to the long protocol with a gonadotropin-releasing hormone (GnRH) agonist. However, a mild or moderate form of OHSS is also possible if the antagonist protocol is used, especially when hCG is used for the final maturation of oocytes. For women at risk of OHSS, GnRH agonist trigger and the freeze-all strategy is advisable. OHSS is one of the most frequent complications, with a 30% rate in IVF cycles.

Conclusion: Providing effective care for OHSS patients begins with early diagnosis, while also evaluating for comorbidities and complications. In addition to that, we should pay more attention to the psychological component of this complication and of infertility as a whole. Compliance with guidelines and evidence-based best practices is essential for medicolegal tenability.

Keywords: assisted reproductive technology (ART); gonadotropin-releasing hormone (GnRH) antagonist protocol; medicolegal viability; ovarian hyperstimulation syndrome (OHSS).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The upper segment represents the negative feedback mechanism between thyroid hormones and TRH/TSH. The right segment (the figure side) presents the gonadotropin effect on folliculogenesis. The left segment (the figure side) presents the impaired hypothalamic–pituitary–gonadal axis, increased LH and decreased FSH, and the increased number of preantral and small antral follicles all contributing to the high serum AMH concentration in PCOS, with the arrest in follicular maturation and its importance for IVF.
Figure 2
Figure 2
Flowchart outlining evidence-based management pathway for OHSS patients.
See this image and copyright information in PMC

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