Research and Reports in Gynecology and Obstetrics

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Can ovarian hyper stimulation free clinic be a reality?

4th International Conference on Obstetrics and Gynecology
November 14-15, 2019 | Singapore

S K Das

Swagat Hospital & Research Centre, India

Keynote : Res Rep Gynaecol Obstet

DOI: 10.35841/2591-7366-C3-007


Ovarian hyper stimulation syndrome (OHSS) is an iatrogenic life-threatening condition in women’s reproductive life, taking place during the process of inducing follicular development & ovulation, especially in ART practice. This iatrogenic complication may start in luteal phase and/or during early pregnancy after ovulation or ovulation induction. OHSS in generally associated with exogenous gonadotropin stimulation, occasionally it can be seen in Clomiphene/ Letrozole induced cycle. It is almost unknown in natural cycle. This condition is HCG dependent & therefore, OHSS happens in spontaneous pregnancies where there is supraphysiological concentration of HCG e.g. in multiple pregnancy and molar pregnancy or when there is FSH receptor mutation increasing its sensitivity to Trophoblastic HCG. OHSS consists of cystic ovarian enlargement, overproduction of ovarian hormones and vasoactive endothelial growth factor (VEGF) which is a potent angiogenic cytokine that stimulates follicular growth, corpus luteum function and ovarian angiogenesis. VEGF is responsible for capillary hyperpermeability & thus fluid shift from intravascular space to third space resulting in a wide range of clinical symptoms (abdominal discomfort, acute abdomen, respiratory distress etc.) and laboratory signs (low hematocrit, low serum albumin etc.) Understanding of the pathophysiology of OHSS is important to prevent & manage the same.

OHSS free clinic protocol aims at: -

1. Identifying primary risk factors (high level AMH, Age, AFC, previous OHSS, PCOS).

2. Selection of low risk stimulation protocols in ART.

3. Avoiding secondary risk factor (high peak E2, retrieval of more than 15 oocytes).

4. Stimulation protocol modification and avoiding HCG trigger.

5. Cancellation of cycle & freezing all embryos to transfer in other date (I.e., zero OHSS in fresh transfer).

6. In vitro maturation technique, which is promising.


S K Das is the Director of Swagat Hospital & Research Centre, Bongaigaon, Assam, India. He graduated (MBBS) from Guwahati University in 1987. He obtained his postgraduate (MD) from Guwahati University 1996, FICOG (India). He has over 10 publications. He has been faculty in various national & international conferences.

E-mail: [email protected]

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