Ovarian Hyperstimulation Syndrome

In the management of women undergoing assisted conception it is essential to provide the most efficacious, cost effective and, most importantly, safe means of ovarian stimulation. In this edition of Human Fertility, we have collected a series of papers which should help guide the practitioner. A multi-national collaborative group, led by Nardo (Conceive International, Reproductive Health Group, Manchester, UK) have synthesised the current evidence on controlled ovarian hyperstimulation regimens, with attention not only to the standard tried and tested protocols but also to consideration of those who respond less well and those at risk of over-response (Controlled ovarian hyperstimulation regimens: a review of the available evidence for clinical practice). It is this latter group, who present the true risk of ovarian hyperstimulation syndrome (OHSS) and are discussed in detail in a series of four papers: Evbuomwan, from the Queen Elizabeth Hospital, Gateshead, UK, presents a fascinating discussion about the latest hypotheses in the pathophysiology of this still enigmatic condition, in particular the role of Osmoregulation (The role of Osmoregulation in the pathophysiology and management of [Severe] OHSS). Baumgarten and colleagues from the University of Nottingham, UK, have performed a meta-analysis on the use of dopamine agonists and shown that their use appears to be effective for the prevention of OHSS but less so for treatment of OHSS (Do dopamine agonists prevent or reduce the severity of ovarian hyperstimulation syndrome in women undergoing assisted reproduction? A systematic review and meta-analysis). Tan and Mathur from Addenbrookes Hospital, Cambridge, UK, present comprehensive Policy and Practice Guidelines on the overall management of this potentially fatal condition (Management of ovarian hyperstimulation syndrome), with clear levels of evidence in the supplementary paper by Mathur (Management of OHSS guidelines). A further contribution on the prevention of OHSS will be ready for publication in the next few months. We hope these papers will make you think in greater depth about the individualisation of treatment regimens for OHSS in order to enhance outcome and minimise risk.