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Ultrasound and Ovarian Hyperstimulation Syndrome

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Ultrasound Imaging in Reproductive Medicine

Abstract

Ultrasound has key roles in the prediction, diagnosis, and treatment of ovarian hyperstimulation syndrome (OHSS). Although there are no perfect tests to anticipate the development of OHSS, antral follicle count (AFC), sonographic evidence of polycystic ovary syndrome, and follicular size and number at the time of egg retrieval have all been evaluated as predictors of OHSS. These sonographic variables can be combined with demographic data (patient age, BMI, etc.), serum markers such as anti-Mullerian hormone (AMH), peak serum estradiol during in vitro fertilization (IVF) stimulation, and number of oocytes retrieved to predict OHSS risk. Once OHSS is suspected, the diagnosis of OHSS is aided by ultrasound findings including presence and volume of abdominal ascites, ovarian size, and presence or absence of pleural effusions and Doppler studies showing venous thromboembolism. The sonographic evaluation of the fluid shifts which occur in OHSS is part of the diagnostic criteria for mild, moderate, severe, and critical OHSS. Proactive management of OHSS hinges on the accurate assessment of clinical severity, and ultrasound features assist the clinician in management decisions. Finally, ultrasound is critical in the treatment of OHSS. Ultrasound-guided transabdominal and transvaginal paracenteses have been shown to markedly improve patient symptoms of OHSS and avoid the need for hospitalization. Thoracentesis to drain pleural effusions is also aided by ultrasound guidance. Because OHSS can lead to serious morbidity and mortality, clinicians must have a high index of suspicion in the identification of patients at risk for OHSS and the diagnosis and treatment once OHSS is recognized. By fully and accurately using ultrasound in the prediction, diagnosis, and treatment of OHSS, clinicians can be proactive in the evaluation and management of this severe iatrogenic complication of ovulation induction.

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Authors and Affiliations

  1. Reproductive Medicine and Surgery Center of Virginia, PLC, Charlottesville, VA, USA

    Laura P. Smith

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  1. Laura P. Smith
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Correspondence to Laura P. Smith .

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Editors and Affiliations

  1. The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Laurel A. Stadtmauer

  2. Institute for Human Reproduction, Chicago, IL, USA

    Ilan Tur-Kaspa

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Smith, L.P. (2019). Ultrasound and Ovarian Hyperstimulation Syndrome. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-16699-1_19

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  • DOI: https://doi.org/10.1007/978-3-030-16699-1_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16698-4

  • Online ISBN: 978-3-030-16699-1

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