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Ovarian hyperstimulation syndrome and complications of ART

https://doi.org/10.1016/j.bpobgyn.2009.02.006Get rights and content

This article reviews serious clinical complications related to assisted reproductive technology (ART) procedures (ovarian stimulation and oocyte aspiration), including ovarian hyperstimulation syndrome (OHSS), bleeding and infection. These complications are rare, but can be severe and even life-threatening. It is important that general practitioners and gynaecologists are aware of these complications, because they will often be the first to be contacted by patients. Similarly, patients should be counselled before starting ART procedures that iatrogenic complications can be associated with ovarian stimulation and/or oocyte aspiration.

Introduction

Infertility is a common problem, with an overall median prevalence of 9%. This prevalence appears to be similar in both the developed and less-developed parts of the world. About 56% of people actually seek medical help and 22% receive medical care. On the basis of the current population, 72.4 million people are currently infertile; of these, approximately 40.5 million are currently seeking infertility medical care.1

The prevalence of infertility is increasing in the developed world. The postponement of pregnancy, a possible increase in male infertility, greater prevalence of obesity and sexually transmitted diseases all contribute to this problem.

There is a tendency for more infertile couples to seek medical help. This is a consequence of more publicity and knowledge around this topic in the general population.

Because infertility is such a common and increasing problem, with more people seeking medical help, we highlight some possible dangerous side effects of ovarian stimulation (OS). We make a distinction between cycle-related short-term and long-term complications of OS. In this review we only discuss the short-term and possibly acute problems associated with OS: ovarian hyperstimulation syndrome (OHSS), thrombo-embolism, adnexal torsion, infection and bleeding as a consequence of oocyte aspiration. Since thrombo-embolism and adnexal torsion are often associated with OHSS, these complications are discussed together under OHSS. Recently, De Sutter et al. estimated, based on available data in the literature, that the prevalence of short-term complications after assisted reproductive technology (ART) is approximately 2%. OHSS is responsible for half of all complications.2

Pregnancy-related complications such as multiple pregnancy, extra-uterine pregnancy, miscarriage and congenital anomalies in children following ART are not discussed in this review.

Section snippets

Complications following oocyte retrieval

Transvaginal ultrasound-guided oocyte retrieval (OR) was first described in 1985 and has become the method of choice for OR in IVF therapy in most fertility centres worldwide.98

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