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Open AccessReview
Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications
by
Giuseppe Gullo
Giuseppe Gullo 1,*
,
Gaspare Cucinella
Gaspare Cucinella 1,
Vukasin Stojanovic
Vukasin Stojanovic 2
,
Mirjana Stojkovic
Mirjana Stojkovic 3,
Carmine Bruno
Carmine Bruno 4,5
,
Adriana Vita Streva
Adriana Vita Streva 1,
Alessandra Lopez
Alessandra Lopez 1
,
Antonio Perino
Antonio Perino 1 and
Susanna Marinelli
Susanna Marinelli 6
1
Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF Unit, University of Palermo, 90146 Palermo, Italy
2
Emergency Medicine Center of Montenegro, Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
3
Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
4
Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
5
Istituto Dermopatico dell’Immacolata (IDI IRCCS), 00167 Rome, Italy
6
School of Law, Polytechnic University of Marche, 60121 Ancona, Italy
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2024, 14(9), 915; https://doi.org/10.3390/jpm14090915 (registering DOI)
Submission received: 3 August 2024
/
Revised: 19 August 2024
/
Accepted: 26 August 2024
/
Published: 28 August 2024
Abstract
Background: Infertility is a highly meaningful issue with potentially life-changing consequences, and its incidence has been growing worldwide. Assisted reproductive technology (ART) has made giant strides in terms of treating many infertility conditions, despite the risk of developing ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening complication. Methods: This narrative review draws upon scientific articles found in the PubMed database. The search spanned the 1990–2024 period. Search strings used included “OHSS” or “ovarian hyperstimulation” and “IVF” and “GnRH” and “hCG”; 1098 results were retrieved and were ultimately narrowed down to 111 suitable sources, i.e., relevant articles dealing with the condition’s underlying dynamics, management pathways, and evidence-based criteria and guidelines, crucial both from a clinical perspective and from the standpoint of medicolegal tenability. Results: The following features constitute OHSS risk factors: young age, low body weight, and polycystic ovarian syndrome (PCOS), among others. GnRH antagonist can substantially lower the risk of severe OHSS, compared to the long protocol with a gonadotropin-releasing hormone (GnRH) agonist. However, a mild or moderate form of OHSS is also possible if the antagonist protocol is used, especially when hCG is used for the final maturation of oocytes. For women at risk of OHSS, GnRH agonist trigger and the freeze-all strategy is advisable. OHSS is one of the most frequent complications, with a 30% rate in IVF cycles. Conclusion: Providing effective care for OHSS patients begins with early diagnosis, while also evaluating for comorbidities and complications. In addition to that, we should pay more attention to the psychological component of this complication and of infertility as a whole. Compliance with guidelines and evidence-based best practices is essential for medicolegal tenability.
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MDPI and ACS Style
Gullo, G.; Cucinella, G.; Stojanovic, V.; Stojkovic, M.; Bruno, C.; Streva, A.V.; Lopez, A.; Perino, A.; Marinelli, S.
Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications. J. Pers. Med. 2024, 14, 915.
https://doi.org/10.3390/jpm14090915
AMA Style
Gullo G, Cucinella G, Stojanovic V, Stojkovic M, Bruno C, Streva AV, Lopez A, Perino A, Marinelli S.
Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications. Journal of Personalized Medicine. 2024; 14(9):915.
https://doi.org/10.3390/jpm14090915
Chicago/Turabian Style
Gullo, Giuseppe, Gaspare Cucinella, Vukasin Stojanovic, Mirjana Stojkovic, Carmine Bruno, Adriana Vita Streva, Alessandra Lopez, Antonio Perino, and Susanna Marinelli.
2024. "Ovarian Hyperstimulation Syndrome (OHSS): A Narrative Review and Legal Implications" Journal of Personalized Medicine 14, no. 9: 915.
https://doi.org/10.3390/jpm14090915
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