Ovarian Hyperstimulation Syndrome Workup

  • Author: Joanna Horwitz, MD; Chief Editor: Richard Scott Lucidi, MD   more...
 
Updated: Mar 23, 2012
 

Laboratory Studies

In ovarian hyperstimulation syndrome (OHSS), the hematocrit is the most important measure in deciding if a patient should be hospitalized. If the patient's hematocrit level is greater than 60% and if she has ascites, hospitalize her immediately.

Laboratory monitoring may involve the following parameters:

  • CBC with differential: This is helpful because decreased intravascular volume leads to hemoconcentration and an increased hematocrit.
  • Complete metabolic panel
    • Liver function: Liver function is decreased, as indicated by increased concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase.
    • Kidney function: Renal function is reduced, BUN and creatinine values are increased, whereas albumin and protein levels are decreased. Electrolyte imbalances, hyperkalemia, and acidosis may be present.
  • Coagulation profile, including the prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR): These findings aid in detecting a hypercoagulable state and in monitoring anticoagulation.
  • Leukocyte count: This count is related to the seriousness of OHSS and to the risk of thromboembolism.[18]
  • Beta-hCG concentration: A beta-hCG measurement is especially useful at more than 12 days after an injection of hCG. A positive result at this stage indicates pregnancy, an endogenous source of hCG for OHSS. hCG upregulates vascular endothelial growth factor (VEGF) receptors, and this upregulation increases third spacing.[19] Mild OHSS may deteriorate to severe OHSS because of the increased availability of hCG.
  • Estradiol levels: Values are increased.

Laboratory findings of a serum estradiol concentration greater than 2000 pg/mL and a progesterone concentration greater than 30 ng/mL in the early part of the luteal phase are warning signs of developing OHSS.[20] (See Deterrence/Prevention.)

Signs that may indicate a progression in severity are increases in hCG level, hematocrit, hypoproteinemia, and hypoalbuminemia (third spacing). Additional signs are decreasing renal and liver function.

OHSS is critical when the signs and symptoms of severe OHSS are present with any of the following findings: renal failure, ARDS, thromboembolism, or a hematocrit level greater than 60%.

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Imaging Studies

  • Ultrasonography may be needed to measure the size of the ovaries, to assess the follicles, and to evaluate ascites (see image below). Ultrasonographic presentation of ovarian hyperstimUltrasonographic presentation of ovarian hyperstimulation syndrome.
  • Chest radiography may be indicated if dyspnea is present.
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Contributor Information and Disclosures
Author

Joanna Horwitz, MD  Staff Physician, Department of Obstetrics and Gynecology, Loyola University Medical Center

Joanna Horwitz, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ramesh S Pundi, MD  Attending Physician, Department of Obstetrics and Gynecology, Genesis Health System, Davenport, Iowa

Ramesh S Pundi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Indian Medical Association

Disclosure: Nothing to disclose.

Josef Blankstein, MD  Chairman, Department of Obstetrics and Gynecology, Rosalind Franklin University of Health Sciences, Chicago Medical School

Josef Blankstein, MD is a member of the following medical societies: Academy of Medicine Cleveland/Northern Ohio Medical Assn, American College of Obstetricians and Gynecologists, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne R Trupin, MD, FACOG  Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center

Suzanne R Trupin, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michel E Rivlin, MD  Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD  Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

For their industrious work in collecting articles and research, Estello Escudero, MA LibSc, Mt Sinai Hospital Library, and Merly Arceo, BA LibSc, Mt Sinai Hospital; and, for his unstinting support and encouragement, Dr Jos Blankstein.

References

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  8. Insler V, Lunenfeld B. Pathogenesis of ovarian hyperstimulation syndrome. In: Gomel V, Leung PCK. In Vitro Fertilization and Assisted Reproduction. Bologna, Italy: Monduzzi Editore; 1997:433-9.

  9. Abramov Y, Elchalal U, Schenker JG. Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril. Apr 1999;71(4):645-51. [Medline].

  10. Polishuk WZ, Schenker JG. Ovarian overstimulation syndrome. Fertil Steril. May-Jun 1969;20(3):443-50. [Medline].

  11. Martin RA, Edraki B, Norris RL. Ovarian hyperstimulation syndrome in the emergency department: a case report. J Emerg Med. Jul-Aug 1994;12(4):481-4. [Medline].

  12. Lyons CA, Wheeler CA, Frishman GN, et al. Early and late presentation of the ovarian hyperstimulation syndrome: two distinct entities with different risk factors. Hum Reprod. May 1994;9(5):792-9. [Medline].

  13. Rutkowski A, Dubinsky I. Ovarian hyperstimulation syndrome: imperatives for the emergency physician. J Emerg Med. Jul-Aug 1999;17(4):669-72. [Medline].

  14. Delvigne A, Demoulin A, Smitz J, et al. The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. I. Clinical and biological features. Hum Reprod. Sep 1993;8(9):1353-60. [Medline].

  15. Stewart JA, Hamilton PJ, Murdoch AP. Thromboembolic disease associated with ovarian stimulation and assisted conception techniques. Hum Reprod. Oct 1997;12(10):2167-73. [Medline].

  16. Speroff L, Fritz M. Clinical Gynecological Endocrinolgy and Infertility. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004:1999-1200.

  17. Levin ER, Rosen GF, Cassidenti DL, et al. Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. J Clin Invest. Dec 1 1998;102(11):1978-85. [Medline].

  18. Whelan JG 3rd, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril. May 2000;73(5):883-96. [Medline].

  19. Wang TH, Horng SG, Chang CL, et al. Human chorionic gonadotropin-induced ovarian hyperstimulation syndrome is associated with up-regulation of vascular endothelial growth factor. J Clin Endocrinol Metab. Jul 2002;87(7):3300-8. [Medline].

  20. Blankstein J, Lunenfeld S, Mashiach S. Introduction of Ovulation and In Vitro Fertilization. Chicago, Ill: YearBook Medical; 1986.

  21. Levin I, Almog B, Avni A, et al. Effect of paracentesis of ascitic fluids on urinary output and blood indices in patients with severe ovarian hyperstimulation syndrome. Fertil Steril. May 2002;77(5):986-8. [Medline].

  22. Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. Aug 1992;58(2):249-61. [Medline].

  23. Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. Feb 15 2012;2:CD008605. [Medline].

  24. Herman A, Raziel A, Strassburger D, et al. The benefits of mid-luteal addition of human chorionic gonadotrophin in in-vitro fertilization using a down-regulation protocol and luteal support with progesterone. Hum Reprod. Jul 1996;11(7):1552-7. [Medline].

  25. Lunenfeld B, Insler V, Glezerman M. Diagnosis and Treatment of Functional Infertility. 3rd ed. Berlin, Germany: Blackwell Wissenschaft; 1993:98.

 
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Ultrasonographic presentation of ovarian hyperstimulation syndrome.
 
 
 
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