21. Ovarian Hyperstimulation Syndrome

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Hi guys I am back with another video , in this video we will be discussing about the ovarian hyper stimulation syndrome , what is the idea of IVF? , it is to retrieve 6 to 15 eggs, controlled ovarian hyper stimulation is to retrieve too many eggs in one cycle in order to increase the chances of IVF. Each egg makes under 150 to 200 pg of Estradiol, so 40 eggs will make 8000 pg. of Estradiol. Greater than 20 eggs that is 3500 pg of Estradiol leads to vascular Endothelial growth factor ; Increase of Renin and prorenin, increase of angiotensin , that is it increases the vascular permeability . Now what does increase in vascular permeability means ? It means fluid shifts which leads to third space collections which causes ascites , pleural effusion, pericardial effusion and oedema . Now what causes in the intra vascular compartment . Intra vascular compartment causes increased thromboembolic phenomenon which leads to brain Emboli, renal emboli , cerebral emboli , hepatic emboli , cardiac emboli, lymph emboli and last but not the least which is death . The signs of the ovary increases during the ovarian hyper stimulation syndrome and it has many follicles which may lead to rupture of ovary , hemorrhage and death . Now let us come to the types of ovarian hyper stimulation syndrome, there are two types: Early ovarian hyper stimulation syndrome and late ovarian hyper stimulation syndrome . In case of early ovarian hyper stimulation syndrome , it occurs 3 to 7 days flowing Human chorionic gonadotropin trigger. In case of late ovarian hyper stimulation syndrome it occurs late 12 to 17 days. It is the result of endogenous HCG from pregnancy which is more severe . Now let us come to know about the predisposing factors causing ovarian hyper stimulation syndrome , the first one is PCOS , the second one is hypogonadotropic hypogonadism, young age low body mass , increased ovarian volume and high antral follicle count , elevated measurements of anti mullerian hormone , the normal range is 2 to 6 per ml is normal range for anti mullerian hormone . Large number of oocytes are collected which is greater than 70. Now let us come to know the most common causes of ovarian hyper stimulation syndrome . The causes are : injections of recombinant FSH , injection human menopausal gonadotropin, . Now the classification, the ovarian hyper stimulation syndrome can be classified into four types : mild ovarian hyper stimulation syndrome , moderate ,severe and critical . Now let us come to know about the treatment, how do we treat ovarian hyper stimulation syndrome?: the first one is daily examination of vitals, input and output charting . CBC , electrolytes , antiemetics , fluid management , we should give fluids to maintain perfusion , normal saline is the best to give , colloids can be given like injection albumin( 20 percent albumin 100 percent over 30 minutes )
We should remove fluids by paracentesis and diuretics cannot be given . This all about about this topic , see you in the next video . Thank you !