Prevention is the ideal treatment of OHSS!!!

Ovarian hyperstimulation syndrome (ohss) is a unique iatrogenic complication of controlledovarian stimulation (coh)/in vitro fertilization (ivf) in reproductive endocrinology occurringduring the luteal phase or early pregnancy. it can have a serious impact on the patient's health.with the expansion of the assisted reproductive techniques (art) from 1978, the incidence ofohss is increasing woridwide.ohss is characterized by gastrointestinal symptoms, ovarianenlargement, fluid shift to the third space, and hemoconcentration. severe cases are associated withthromboembolic phenomena, respiratory distress , liver dysfunction and renal failure. ohss is morecommon among woman who are young , thin and have pcos or multiple allergies. vascularendothelial growth factor (vegf) and other cytokines are pivotal in the pathogenesis of ohss.in the prevention of any disease, it should be emphasized that the possibility of primary preventiondepends on two main requirements, first, the etiology of the disease and predisposing factors ; andsecond, it must be feasible to avoid or manipulate such factors as paint of a prevention strategy.this strategy for preventing ohss and its severity have included prediction of women at risk; thefirst step in prevention is identification of patients at risk by the recognition of risk factors. as thisis not always possible, there are several ways of avoiding developing of the syndrome. thestimulation phase has to be carefully monitored (regular ultrasound and estradiol measurements),and further interventions need to be implemented if signs of hyper-response are present. the aim ofthis systemic review of the literature is to answer this question: can we prevent severe ohss.canceling the cycle , modification of method to trigger ovulation administration ofmacromolecules, coasting approach, timed unilateral or bilateral aspiration of one or two ovariesperformed before or after hcg administration, in vitro maturation (ivm), elective cryopreservationof all embryos, and laser or electrocautery of one or both ovaries, have been showed to beassociated with a reduced risk of ohss by some research groups. the effect of combined methodshould be assessed.finally, apart from canceling, none of these approaches was totally efficient, although most ofthe above-mentioned methods decrease the incidence in patients at high risk of ohss; but overallprevention is the ideal treatment ofohss.