Symposium: Update on prediction and management of OHSS
Prevention of OHSS – dopamine agonists

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Abstract

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction, which may seriously affect the patient's health, with 0.1–2.0% of the patients developing severe forms of the syndrome. OHSS signs and symptoms are direct consequences of fluid shift from capillaries to the third space due to increased vascular permeability. The mechanisms of OHSS pathophysiology remain unknown but evidence obtained in animal models prove that vascular endothelial growth factor (VEGF) is directly involved and the inhibition of the VEGF system could prevent OHSS from occurring. Dopamine agonists impede the phosphorylation of the VEGF receptor 2 and reduce the incidence and severity of OHSS with a safe clinical profile. As far as is known, this is the first pathophysiological approach for treatment and prevention of OHSS.

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Dr Busso is a gynaecologist, specializing in reproductive medicine. He is currently a postgraduate student at the University of Valencia, Spain. He was a fellow of the Reproductive Endocrinology unit of the Instituto Valenciano de Infertilidad – Valencia. His special interests include pathophysiology of ovarian hyperstimulation syndrome and natural and minimal stimulation cycles for ovarian stimulation.

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      Several studies indicate that the development of OHSS is mediated by the presence of human chorionic gonadotropin (hCG), exogenous or endogenous.5 The administration of hCG would lead to an increased vascular permeability, mediated by the receptors of vascular endothelial growth factor (VEGF) present in the theca-cells and granulosa.5,10,11 Prostaglandins, inhibin, mediators of the inflammatory system and activation of the renin-angiotensin-aldosterone system are also factors involved in the etiology of OHSS.5,12

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    Dr Busso is a gynaecologist, specializing in reproductive medicine. He is currently a postgraduate student at the University of Valencia, Spain. He was a fellow of the Reproductive Endocrinology unit of the Instituto Valenciano de Infertilidad – Valencia. His special interests include pathophysiology of ovarian hyperstimulation syndrome and natural and minimal stimulation cycles for ovarian stimulation.

    Declaration: The authors report no financial or commercial conflicts of interest.

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