OHSS Extra Questions

1. The growth factor implicated in mediating the effects of ovarian hyper stimulation is:

2. Women with OHSS are specially prone to:

3. A woman with tubal disease is advised to have IVF treatment to maximise her chances of pregnancy. On reading the information leaflet, she is very concerned about the risks of ovarian hyper stimulation syndrome. What is the chance of developing severe ovarian hyper stimulation syndrome (OHSS) and requiring hospitalisation in women undergoing controlled ovarian hyper stimulation?

4. Following an IVF treatment cycle where 15 oocytes were collected, a patient presents to the clinic with abdominal pain, nausea and vomiting. An ultrasound scan is performed, which shows the ovaries to be enlarged with a mean diameter of 10 cm. There is a small amount of ascites. What is the diagnosis?

5. What type of electrolyte disturbance is often seen in association with severe cases of OHSS?

6. A woman with a severe cases of OHSS initially presented with tense ascites, oliguria and a haematocrit of 46%.She was treated with appropriate fluid replacement and the haematocrit is now in the normal range. However, she remains markedly oliguric. What is the appropriate management?

7. A 36-year-old para 1 is undergoing an IVF cycle. She has egg retrieval and two fresh embryos are transferred. Her initial beta human chorionic gonadotropin is 1600 mIU/ml, and she begins to develop abdominal pain, nausea and vomiting. An ultrasound reveals two gestational sacs and free abdominal fluid. She is not short of breath, her pulse oximetry is 98% on room air and electrolytes and haematocrit and liver function tests are within normal limits. What grade of ovarian hyper stimulation syndrome should she be categorized as having?

8. A 35-year-old para 0 is in the midst of an IVF cycle. She has undergone egg retrieval following human chorionic gonadotropin administration, and you have just implanted two fresh embryos. What is the chance that she will develop OHSS?

9. A 37-year-old para 0, who has undergone controlled ovarian stimulation for IVF treatment 3 weeks previously, presents with abdominal pain, bloating, nausea and vomiting. She is known to have PCOS and had not ovulated previously with clomifene citrate treatment. She went on to receive antagonist recombinant FSH protocol and was later given human chorionic gonadotropin to trigger ovulation. Ultrasound has shown evidence of ascites with an ovarian size of 14 cm. Her haematocrit was 46%. The patient was admitted to hospital for inpatient treatment. What is the recommended regime of thromboprophylaxis?