Neurovascular Complications of Ovarian Hyperstimulation Syndrome (OHSS): From Pathophysiology to Recent Treatment Options
Rocco S. Calabro, Giuseppe Gervasi, Antonino Leo, Rosaria De Luca, Tina Balletta, Carmela Casella, Onofrio Triolo and Placido Bramanti
Affiliation: Behavioral and Robotic Neurorehabilitation Laboratory, IRCCS Centro Neurolesi "Bonino Pulejo", via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy.
Keywords: Arterial ischemia assisted reproductive technology, follicle stimulation hormone, iatrogenic complications, mortality
risk, neurovascular complications, ovarian hyperstimulation syndrome.
Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of ovulation induction, which
has a very serious impact on the patient’s health, as it is often associated with a high morbidity and mortality risk. Indeed,
patients classified as having severe OHSS presented with liquid imbalance signs (such as rapid weight gain, tense ascites,
respiratory difficulty and progressive oliguria), which are related to the fluid shift from the intravascular space to third
space compartments subsequent to an increased capillary permeability. In this way, cardiovascular system findings include
decreased intravascular volume, decreased blood pressure, decreased central venous perfusion, and compensatory
increased heart rate and cardiac output with arterial vasodilation might be found concomitantly. Notwithstanding that venous
thromboembolic phenomena are a possible complication in advanced phases of OHSS, arterial ischemia involving
the cerebral circulation is a rare but recently reported problem. The pathogenesis of thromboembolism in OHSS is not
fully understood, even though hemoconcentration and blood hyperviscosity seem to play a role in developing thrombotic
changes into both venous and arterial system. Interestingly, the presence of cardiac abnormalities in combination with inherited
or acquired hypercoagulable state seems to increase the risk of cerebral infarct in these subjects, as recently shown
by our group. This review is aimed at investigating the pathomechanism and the management of neurovascular complications
related to OHSS, including new treatment options.
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