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Ovarian Hyperstimulation Syndrome

This is a book on a very important subject by authors from all over the world who are experienced in the field of assisted conception. Ovarian hyperstimulation syndrome (OHSS) is a well-known complication of assisted conception, which, unfortunately, occurs too often. It is an iatrogenic disease that can cause serious complications and which has even led to death in some cases. Such complications occur in women who are mainly young and otherwise healthy and may be undergoing treatment such as egg donation or intracytoplasmic sperm injection for male factor infertility. It is vital to carry out assisted conception techniques as safely as possible.

The book covers physiology, immunology, preventive measures, complications and the treatment of complications in OHSS. After a short descriptive history in chapter 1, chapter 2 covers epidemiology and primary risk factors, including the evidence for primary risk factors. In chapter 3, secondary risk factors during stimulation are discussed. The subjects of serum estradiol and the numbers of follicles and oocytes collected are given particular consideration. Other risk factors are discussed, together with the available evidence to support them. Clinical manifestations and complications are covered in chapters 4, 5 and 6.

Chapter 7 deals with the classification of OHSS, how it has evolved and how it is classified now. In chapters 9, 10 and 11 the various systems involved in the pathophysiology of OHSS are discussed, while chapter 12 covers immunological aspects. Various factors that have been postulated as being responsible for OHSS are also discussed in chapter 9. These include cytokines and vascular endothelial growth factors. Our knowledge of genetic aspects of OHSS is limited and chapter 13 addresses this topic.

The treatment of OHSS is an important topic and this book covers the clinical management and handling of complications, as well as newer perspectives on treatment in chapters 14, 15 and 16. In clinical practice, OHSS differs in severity. Chapter 17 covers intensive care management of OHSS, while chapter 18 considers outpatient management. These are important chapters and they should be read by all those who care for women with OHSS. Primary prevention of complications is a much better option than treatment. Primary and secondary prevention is covered in chapters 19 to 23 and 25. The book concludes by summarising the guidelines of management. These chapters are very informative on how to manage complications and the meaning and significance of various tests. They also describe how and when to undertake procedures, such as tapping of ascites.

This is a very good book, which should be read by all those providing assisted conception techniques. It should be available at all facilities, such as intensive care units, gynaecology wards and A&E units, that provide care for women with OHSS. This is especially so in some countries; in the United Kingdom, for example, the majority of assisted conception treatment is provided in independent units but the complications are likely to be dealt with in NHS hospitals. The availability of this book in places where OHSS is not often seen will, hopefully, enable the carers of women with OHSS to provide the appropriate treatment early on and avoid complications.

We will only prevent morbidity and mortality from this iatrogenic disease if those undertaking ovarian stimulation, as well as those looking after women with OHSS, fully understand the disease, the process and its correct management. This book goes a long way to help.

Umesh Acharya, FRCOG, Consultant in Gynaecology and Reproductive Medicine¹

^1. South West Centre for Reproductive Medicine, Derriford Hospital, Plymouth PL6 8DH, UK

Informa Healthcare, 2006
ISBN 978-1842143285
Hardback, 320 pages, £110

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Acharya, U. Search for Related Content PubMed Articles by Acharya, U.