卵巣過剰刺激症候群(OHSS)の病態と管理(内分泌)

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Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication arising form treatment with gonadotropin for induction of follicular growth. Severe ascites and pleural effusion, induced by increased vascular permeability, are characteristic for OHSS. In mild cases, there may be symptoms of abdominal bloating, nausea, and vomiting. In severe cases, OHSS may be associated with enlargement ovaries, ascites, pleural effusion, and even adult respiratory syndrome. Biochemically, there is hemoconcentration, hypercoagulability, and electrolyte imbalance. Critical cases may experience thrombosis and renal failure. There are two distinct forms : eraly-onset and late-onset OHSS. The early-onset OHSS occurs 5.88 ± 5.21 day after administration of HCG, whereas the late-onset OHSS is identified 12.81 ± 8.96 day after ovulatory dose of HCG and frequently is associated with pregnancy. Although the exact pathogenesis of OHSS is still unknown, the biochemical changes in OHSS can be explained in a number of ways. The crucical event appears to be an increase in capillary permeability. The cause of this increase in permeability is uncertain, but evidence suggests that the pathogenesis of OHSS may involve the immune system, various inflammatory mediators, ovarian renin-angiotensin system, kallikrein-kinin system and growth factors. Of these, vascular endothelial growth factor (VEGF) has beenimplicated as having a major role in the development of OHSS. Follicular fluid was shown to contain VEGF by Western blot. The vascular permebility was largely blocked by antiserum against VEGF. Cultured granulose cells are known to produce VEGF, and this production is increased in a time- and dose-dependent manner by HCG. Serum VEGF concentrations during the course of OHSS have been reported to reflect the clinical severity of the disease. However, the exact role of these mediators is still uncertain and requires clarification. Thromboembolic phenomena are the ultimate complication of OHSS, and are sometimes fatal despite appropriate treatment. As we have no specific treatment for this severe OHSS, we have to base our decisions about preventive strategies. So far, some preventive methods have been reported. The following particular preventive strategies were reviewed : canceling the cycle, modifying the methods of ovulation triggering, prolonged coasting, administration of albumin and cryopreservation of all embroys.
社団法人日本産科婦人科学会の論文
2003-08-01

卵巣過剰刺激症候群(OHSS)の病態と管理(内分泌)

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