ABSTRACT
OHSS is an iatrogenic condition. The most effective management of OHSS is the accurate prediction and prevention of the disease. Ultrasound scanning and endocrine monitoring of follicular development are the main ways of prediction of the development of OHSS during ovarian stimulation. All patients undergoing ovarian stimulation, whether to correct anovulation or for assisted fertility techniques, should have a pretreatment ultrasound scan and if polycystic ovaries are detected, the dose of gonadotropin should be lowered, titrated gradually and slowly, and ultrasonographic follicular assessment and serum estradiol levels measured on day 5 of stimulation of IVF cycles, so that the dose can be adjusted accordingly, if needs be, for prevention of overstimulation. If pituitary desensitization has been used one should be sensitive to the loss of the normal ‘protection’ of the ovary caused by the block to estrogen-mediated positive feedback of LH release. If a long protocol of GnRH analog treatment is followed by treatment with one of the pure FSH preparations, one must also be aware that the lack of LH changes the usual relationship of follicle maturation and number to circulating estradiol levels. In this situation measurement of serum estradiol concentrations underestimates follicle development. It is therefore essential that endocrine monitoring is supported by high-quality ultrasound, otherwise low circulating estradiol concentrations may encourage further and
