Report an error   
Advanced Search

Problems encountered while managing a case of severe ovarian hyperstimulation syndrome.


Ma. Isidora Margarit Yap-Garcia,
Delfin  A. Tan

Related Institution

Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, - St. Luke's Medical Center, Quezon City, Metro Manila, Philippines

Publication Information

Publication Type
Sub Type
Journal Article, Original
Philippine Journal of Reproductive Endocrinology and Infertility
Date of Publication
January-December 2010


This is the case of a 26 year-old nulligravida with Polycystic Ovary Syndrome who developed severe Ovarian Hyperstimulation Syndrome (OHSS) during ovulation induction for Intrauterine Insemination (IUI). Three problems were encountered during treatment. The first was whether to convert a planned ovulation induction and IUI, that resulted in multiple follicular development, to an in vitro Fertilization - Intracytoplasmic Sperm Injection cycle. The second problem was determining what strategies are relevant in preventing OHSS in a woman at high risk for developing severe hyperstimulation. The third problem was why, when and how to employ abdominal paracentesis in the management of severe OHSS. Though the patient's course was turbulent, management was successful. She is now awaiting embryo transfer and, ultimately, motherhood.


1. Whelan, JG , Vlahos, NF . The ovarian hyperstimulation syndromeFertil Steril 73(5): 2000
2. Practice Committee of the American Society of Reproductive MedicineFertil Steril 90, S188-193, 2008
3. Papanicolaou, EG , Pozzobon, C , Kolibianakis, EM , Camus, M , Tournaye, F , Fatemi, HM , Van Steriteghem, A . Incidence and prediction of ovarian hyperstimulation in women undergoing gonadotropin releasing hormone antagonist in vitro fertilization cyclesFertil Steril 85(1): 2006
4. Baba, T. , Endo, T. , Kitajama, Y. , Kamiya, H. , Morikawa, O. , Saito, T. . Spontaeneous ovarian hyperstimulation syndrome and pituitary adenoma: incidental pregnancy triggers catastrophic event.Fertil Steril 92, 390, 2009
5. Enskog, A. , Unander, M. , Nilsson, L. , Brannstrom, M. . Prospective study of the clinical laboratory parameters of patients in whom ovarian hyperstimulation syndrome developed during controlled ovarian hyperstimulationFertil Steril 71(5): 1999
6. Humaidan, P , Quartarolo, J , Papanicolaou, EG . Preventing ovarian hyperstimulation syndrome: guidance for the clinicianFertil Steril 2010
7. Pellicer, A. , Albert, C. , Mercader, A. , Bonilla-Musoles, F. , Simon, C. . The pathogenesis of ovarian hyperstimulation syndrome: in vivo studies investigating the role of interleukin 1b, interleukin-6, and vascular endothelial growth factor.Fertil Steril 71, 482-489, 1999
8. Rizk, B . Ovarian hyperstimulation syndrome: epidemiology, pathophysiology, prevention and management Cambridge: Cambridge University Press, 2006.
9. Mathur, RS , Akande, V , Keay, S , Hunt, LP , Jenkins, JM . Distinction between hyperstimulation syndrome: an organized compartment syndromeFeril Steril 73(3): 2000
10. Golan, A. , Ron-EI, R. , Herman, A. , Soffer, Y. , Weinraub, Z. , Caspi, E. . Ovarian hyperstimulation syndrome: an update reviewObstet Gynecol 44, 430-440, 1989
11. Grossman, LC , Michalakis, KG , Browne, H , Payson, MD , Segars, JH . The pathophysiology of ovarian hyperstimulation syndrome: anm unrecognized compartment syndromeFertil Steril 2010
12. Costello, MF , Chapman, M , Conway, U . A systematic review and meta-analysis of randomized controlled trials on the metformin co-administration during gonadotropin ovulation induction orIVF in women with polycystic ovary syndrome.Hum Reprod 21(6): 2006
13. Smith, LP , Hacker, MR , Alper, MM . Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis.Fertil Steril 92(6): 2009
14. Yee, B. , Levin, ER , Rosen, GF , Carnidenti, DL . Role of vascular endothelial growth factor (VEGF) massengerribonucleic acid (mRNA) expression in leutinized human granulosa cells in vitro.J Clin Endocrinol Metab 77, 1723-1752,
15. Tummon, I , Gavrilova-Jordan, L , Alleman, MC , Session, D . Polycystic ovaries and ovarian hypestimulation syndrome: a systematic reviewActa Obstet Gynecol Scand 84(7): 2005
16. Bellver, J. , Fernando, M. , Garrido, N. , Pellicer, A. . Blood group and ovarian hyperstimulation.Fertil Steril 93, 270-271, 2010
17. Palomba, S. , Falbo, A. , Orio, F. , Manguso, F. , Russo, T. , Tolino, A. , Coalo, A. , Dale, B. , Zullo, F. . A randomized controlled trial evaluating metformin pre-treatment and co-administration in non-obese, insulin resistant women with polycystic ovary syndrome treated with controlled ovarian hyperstimulation plus timed intercourse or intrauterine inseminatioHum Reprod 20(10): 2005
18. Rice, S. , Christoforidis, N. , Gadd, C. , Nikolaou, D. , Seyani, L. , Donaldson, A. , Margara, R. , Hardy, K. , Franks, S. . Impaired insulin-dependent glucose metabolism in glanulosa-lutein cells from anovulatory women with polycystic ovaries.Hum Reprod 20(2): 2005
19. Dahl-Lyons, CA , Wheeler, CA , Frishman, GN , Hacket, RJ , Seifer, DB , Haniry, RV . Early and late presentation of the ovarian hyperstimulation syndrome: two distinct entities with different risk factors.Hum Reprod 9, 792-799, 1994
20. Schenker, JG , Weinstein, D . Ovarian hyperstimulation syndrome: a current survey.Fertil Steril 30, 255-268, 1978
21. Practice Committee, American Society for Reproductive MedicineFertil Steril 86(5): 2006
22. Kashyap, S. , Leveille, M. , Wells, G. . Low dose human chorionic gonadotropin reduces the incidence of early and severe ovarian hyperstimulation syndrome.Fertil Steril 86(2): 2006

Contact Details

Contact Person
Affiliated Institution
Contact Number

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 2 Fulltext Print Format
Philippine Council for Health Research and Development Library Box No. 2 Fulltext pdf (Request Document)

©2023 HERDIN. All rights reserved. | Contact Us | Keep up to date