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Reducing Risk in Fertility Treatment pp 35–57Cite as

Ovarian Hyperstimulation Syndrome

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Abstract

Ovarian hyperstimulation syndrome (OHSS) is a complication of ovarian stimulation precipitated by hCG or LH. Pre-treatment risk factors include polycystic ovaries and markers of an elevated ovarian reserve, as well as an excessive ovarian response during stimulation. However, many cases occur in situations not thought to be at high risk, making it important for clinicians and patients to maintain awareness of OHSS.

Tailoring stimulation regimes to the risk of OHSS may reduce the incidence, with GnRH antagonist use carrying a lower risk than GnRH agonist. Reducing hCG exposure by use of GnRH agonist trigger, avoiding hCG luteal support, and cryopreservation of all embryos is associated with a reduced risk of OHSS. Patient information is key to managing the risk of OHSS, along with close coordination and sharing of protocols between fertility clinics and acute units. Most women with OHSS may be managed supportively as outpatients, with hospital admission for severe cases and where outpatient follow-up cannot be ensured. Oral rehydration, relief of pain and nausea, and thrombosis prevention are important aspects of management. Paracentesis of ascites may improve symptoms and hasten resolution of OHSS. The syndrome lasts longer and tends to be more severe if the patient conceives, necessitating closer observation and monitoring.

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References

  1. Chen SU, Chou CH, Lin CW, Lee H, Wu JC, Lu HF, et al. Signal mechanisms of vascular endothelial growth factor and interleukin-8 in ovarian hyperstimulation syndrome: dopamine targets their common pathways. Hum Reprod. 2010;25(3):757–67.

    Article  CAS  PubMed  Google Scholar 

  2. McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning Jr RV, et al. Vascular endothelial growth factor as capillary permeability agens in ovarian hyperstimulation syndrome. Lancet. 1994;344:235–6.

    Article  CAS  PubMed  Google Scholar 

  3. Abramov Y, Barak V, Nisman B, Schenker JG. Vascular endothelial growth factor plasma levels correlate to the clinical picture in severe ovarian hyperstimulation syndrome. Fertil Steril. 1996;67:261–5.

    Article  Google Scholar 

  4. Ludwig M, Bauer O, Lopens A, Jelkmann W, Diedrich K. Serum concentration of vascular endothelial growth factor cannot predict the course of severe ovarian hyperstimulation syndrome. Hum Reprod. 1998;13(1):30–2.

    Article  CAS  PubMed  Google Scholar 

  5. Mathur R, Hayman G, Bansal A, Jenkins J. Serum vascular endothelial growth factor levels are poorly predictive of subsequent ovarian hyperstimulation syndrome in highly responsive women undergoing assisted conception. Fertil Steril. 2002;78(6):1154–8.

    Article  PubMed  Google Scholar 

  6. Pietrowski DL, Szabo L, Sator M, Just A, Egarter C. Ovarian hyperstimulation syndrome is correlated with a reduction of soluble VEGF receptor protein level and a higher amount of VEGF-A. Hum Reprod. 2012;27(1):196–9. doi:10.1093/humrep/der349. Epub 2011 Oct 20.

    Article  CAS  PubMed  Google Scholar 

  7. Smits G, Olatunbosun O, Delbaere A, Pierson R, Vassart G, Costagliola S. Ovarian hyperstimulation syndrome due to a mutation in the follicle-stimulating hormone receptor. N Engl J Med. 2003;349(8):760–6.

    Article  CAS  PubMed  Google Scholar 

  8. Daelemans C, Smits G, Daelemans C, Smits G, de Maertelaer V, Costagliola S, et al. Prediction of severity of symptoms in iatrogenic ovarian hyperstimulation syndrome by follicle-stimulating hormone receptor Ser680Asn polymorphism. J Clin Endocrinol Metab. 2004;89:6310–5.

    Article  CAS  PubMed  Google Scholar 

  9. Simoni M, Tempfer CB, Destenaves B, Fauser BC. Functional genetic polymorphisms and female reproductive disorders: part I: polycystic ovary syndrome and ovarian response. Hum Reprod Update. 2008;14(5):459–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Neulen JL, Yan Z, Raczek S, Weindel K, Keck C, Weich HA, Marmé D, Breckwoldt M. Human chorionic gonadotropin-dependent expression of vascular endothelial growth factor/vascular permeability factor in human granulosa cells: importance in ovarian hyperstimulation syndrome. J Clin Endocrinol Metab. 1995;80(6):1967–71.

    CAS  PubMed  Google Scholar 

  11. Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:901–7.

    Article  CAS  PubMed  Google Scholar 

  12. Golan A, Ron-El R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44:430–40.

    Article  CAS  PubMed  Google Scholar 

  13. Mathur R, Evbuomwan I, Jenkins J. Prevention and management of ovarian hyperstimulation syndrome. Curr Obstet Gynaecol. 2005;15:132–8.

    Article  Google Scholar 

  14. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update. 2002;8(6):559–77.

    Article  CAS  PubMed  Google Scholar 

  15. Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod. 2005;20(12):3293–300.

    Article  PubMed  Google Scholar 

  16. Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, et al. Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril. 2009;92(5):1586–93.

    Article  CAS  PubMed  Google Scholar 

  17. Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN, et al. Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod. 2008;23(1):160–7.

    Article  CAS  PubMed  Google Scholar 

  18. Yates AP, Rustamov O, Roberts SA, Lim HYN, Pemberton PW, Smith A, et al. Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod. 2011;26:2353–62.

    Article  CAS  PubMed  Google Scholar 

  19. Nelson SM, Yates RW, Lyall H, Jamieson M, Traynor I, Gaudoin M, et al. Anti-Müllerian hormone-based approach to controlled ovarian stimulation for assisted conception. Hum Reprod. 2009;24(4):867–75.

    Article  CAS  PubMed  Google Scholar 

  20. Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657–63. doi:10.1016/j.fertnstert.2012.05.042.

    Article  PubMed  Google Scholar 

  21. Kwee J, Elting ME, Schats R, McDonnell J, Lambalk CB. Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization. Reprod Biol Endocrinol. 2007;5:9. doi:10.1186/1477-7827-5-9.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Yovich J, Stanger J, Hinchliffe P. Targeted gonadotrophin stimulation using the PIVEt algorithm markedly reduces the risk of OHSS. Reprod Biomed Online. 2012;24(3):281–92.

    Article  CAS  PubMed  Google Scholar 

  23. Gremeau AS, Andreadis N, Fatum M, Craig J, Turner K, McVeigh E, et al. In vitro maturation or in vitro fertilization for women with polycystic ovaries? A case-control study of 194 treatment cycles. Fertil Steril. 2012;98(2):355–60.

    Article  PubMed  Google Scholar 

  24. Rimington MR, Walker SM, Shaw RW. The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum Reprod. 1997;12(7):1443–7.

    Article  CAS  PubMed  Google Scholar 

  25. Marci R, Senn A, Dessole S, Chanson A, Loumaye E, Grandi P, et al. A low-dose stimulation protocol using highly purified follicle-stimulating hormone can lead to high pregnancy rates in in vitro fertilization patients with polycystic ovaries who are at risk of a high ovarian response to gonadotropins. Fertil Steril. 2001;75(6):1131–5.

    Article  CAS  PubMed  Google Scholar 

  26. van Wely M, Kwan I, Burt AL, Thomas J, Vail A, Van der Veen F, et al. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. Cochrane Database Syst Rev. 2011;16;(2):CD005354. doi:10.1002/14651858.CD005354.pub2.

  27. Al-Inany HG, Youssef MAFM, Aboulghar M, Broekmans FJ, Sterrenburg MD, Smit JG, et al. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Sys Rev. 2011; (5):CD001750. doi:10.1002/14651858.CD001750.pub3.

  28. Merviel P, Najas S, Campy H, Floret S, Brasseur F. Use of GNRH antagonists in reproductive medicine. Minerva Ginecol. 2005;57(1):29–43.

    CAS  PubMed  Google Scholar 

  29. Kamath MS, Mangalraj AM, Muthukumar KM, George K. Gonadotrophin releasing hormone antagonist in IVF/ICSI. J Hum Reprod Sci. 2008;1(1):29–32.

    Article  Google Scholar 

  30. Humaidan P, Papanikolaou EG, Kyrou D, Alsbjerg B, Polyzos NP, Devroey P, et al. The luteal phase after GnRH-agonist triggering of ovulation: present and future perspectives. Reprod BioMed Online. 2012;24:134–41.

    Article  CAS  PubMed  Google Scholar 

  31. Youssef MAFM, Van der Veen F, Al-Inany HG, Griesinger G, Mochtar MH, Aboulfoutouh I, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database Syst Rev. 2011;(1):CD008046. doi:10.1002/14651858.CD008046.pub3.

  32. Humaidan P, Kol S, Papanikolaou EG. on behalf of The Copenhagen GnRH Agonist Triggering Workshop Group. GnRH agonist for triggering of final oocyte maturation: time for a change of practice? Hum Reprod Update. 2011;17(4):510–24.

    Article  CAS  PubMed  Google Scholar 

  33. Seyhan A, Ata B, Polat M, Son WY, Yarali H, Dahan MH. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum Reprod. 2013;28(9):2522–8.

    Article  CAS  PubMed  Google Scholar 

  34. Babayof R, Margalioth EJ, Huleihel M, Amash A, Zylber-Haran M, Gal M, et al. Serum Inhibin A, VEGF and TNFa levels after triggering oocyte maturation with GnRH agonist compared with HCG in women with polycystic ovaries undergoing IVF treatment: a prospective randomized trial. Hum Reprod. 2006;21:1260–5.

    Article  CAS  PubMed  Google Scholar 

  35. Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian Hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril. 2008;89:84–91.

    Article  CAS  PubMed  Google Scholar 

  36. Papanikolaou EG, Verpoest W, Fatemi H, Tarlatzis B, Devroey P, Tournaye H. A novel method of luteal supplementation with recombinant luteinizing hormone when a gonadotropin-releasing hormone agonist is used instead of human chorionic gonadotropin for ovulation triggering: a randomized prospective proof of concept study. Fertil Steril. 2011;95:1174–7.

    Article  CAS  PubMed  Google Scholar 

  37. Pirard C, Donnez J, Loumaye E. GnRH agonist as luteal phase support in assisted reproduction technique cycles: results of a pilot study. Hum Reprod. 2006;21:1894–900.

    Article  CAS  PubMed  Google Scholar 

  38. Nargund G, Hutchison L, Scaramuzzi R, Campbell S. Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles. RBM Online. 2007;14(6):682–5.

    CAS  PubMed  Google Scholar 

  39. Chang P, Kenley S, Burns T, Denton G, Currie K, DeVane G, et al. Recombinant human chorionic gonadotropin (rhCG) in assisted reproductive technology: results of a clinical trial comparing two doses of rhCG (Ovidrel) to urinary hCG (Profasi) for induction of final follicular maturation in in vitro fertilization-embryo transfer. Fertil Steril. 2001;76:67–74.

    Article  CAS  PubMed  Google Scholar 

  40. Benavida CA, Davis O, Kligman I, Moomjy M, Liu HC, Rosenwaks Z. Withholding gonadotrophin administration is an effective alternative for the prevention of ovarian hyperstimulation syndrome. Fertil Steril. 1997;67:724–7.

    Article  Google Scholar 

  41. Dhont M, Van der Straeten F, De Sutter P. Prevention of severe ovarian hyperstimulation by coasting. Fertil Steril. 1998;70:847–50.

    Article  CAS  PubMed  Google Scholar 

  42. Tortoriello DV, McGovern PG, Colon JM, Skurnick JH, Lipetz K, Santoro N. “Coasting” does not adversely affect cycle outcome in a subset of highly responsive in vitro fertilization patients. Fertil Steril. 1998;69:454–60.

    Article  CAS  PubMed  Google Scholar 

  43. Tozer A, Iles R, Iammarrone E, Guillott C, Al-Shawaf T, Grudzinskas J. The effects of coasting on follicular fluid concentrations of vascular endothelial growth factor in women at risk of developing ovarian hyperstimulation syndrome. Hum Reprod. 2004;19:522–8.

    Article  CAS  PubMed  Google Scholar 

  44. D’Angelo A, Brown J, Amso NN. Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2011;(6):CD002811. doi:10.1002/14651858.CD002811.pub3.

  45. García-Velasco JA, Isaza V, Quea G, Pellicer A. Coasting for the prevention of ovarian hyperstimulation syndrome: much ado about nothing? Fertil Steril. 2006;85:547–54.

    Article  PubMed  Google Scholar 

  46. Egbase PE, Sharhan MA, Grudzinskas JG. Early unilateral follicular aspiration compared with coasting for the prevention of severe ovarian hyperstimulation syndrome: a prospective randomized study. Hum Reprod. 1999;14(11):2922–3.

    Article  Google Scholar 

  47. Mansour R, Aboulghar M, Serour G, Amin Y, Abou-Setta AM. Criteria of a successful coasting protocol for the prevention of severe ovarian hyperstimulation syndrome. Hum Reprod. 2005;20(11):3167–72.

    Article  PubMed  Google Scholar 

  48. Endo T, Honnma H, Hayashi T, Chida M, Yamazaki K, Kitajima Y, et al. Continuation of GnRH agonist administration for 1 week, after hCG injection, prevents ovarian Hyperstimulation syndrome following elective cryopreservation of all pronucleate embryos. Hum Reprod. 2002;17(10):2548–51.

    Article  CAS  PubMed  Google Scholar 

  49. Tang T, Glanville J, Orsi N, Barth JH, Balen AH. The use of metformin for women with PCOS undergoing IVF treatment. Hum Reprod. 2006;21(6):1416–25.

    Article  CAS  PubMed  Google Scholar 

  50. Tso LO, Costello MF, Andriolo RB, Freitas V. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2009;(2):CD006105. doi:10.1002/14651858.CD006105.pub2.

  51. Doldi N, Persico P, Di Sebastiano F, Marsiglio E, Ferrari A. Gonadotropin-releasing hormone antagonist and metformin for treatment of polycystic ovary syndrome patients undergoing in vitro fertilization-embryo transfer. Gynecol Endocrinol. 2006;22(5):235–8.

    Article  PubMed  Google Scholar 

  52. Alvarez C, Martí-Bonmatí L, Novella-Maestre E, Sanz R, Gómez R, Fernández-Sánchez M, et al. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. J Clin Endocrinol Metab. 2007;92:2931–7.

    Article  CAS  PubMed  Google Scholar 

  53. Youssef MA, van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459–66.

    Article  CAS  PubMed  Google Scholar 

  54. Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis. Fertil Steril. 2011;95(1):188–96.

    Article  CAS  PubMed  Google Scholar 

  55. Bellver J, Muñoz EA, Ballesteros A, Soares SR, Bosch E, Simón C, et al. Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: a randomized controlled study. Hum Reprod. 2003;18(11):2283–8.

    Article  CAS  PubMed  Google Scholar 

  56. Mathur RS, Joels LA, Jenkins JM. Ovarian hyperstimulation syndrome may be more likely if multiple pregnancy occurs following assisted conception. Acta Genet Med Gemellol (Roma). 1995;44(3–4):233–5.

    CAS  Google Scholar 

  57. Schwärzler P, Abendstein BJ, Klingler A, Kreuzer E, Rjosk HK. Prevention of severe ovarian hyperstimulation syndrome (OHSS) in IVF patients by steroidal ovarian suppression–a prospective randomized study. Hum Fertil (Camb). 2003;6(3):125–9.

    Article  Google Scholar 

  58. Shrivastav P, Nadkarni P, Craft I. Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity. Hum Reprod. 1994;9:812–4.

    CAS  PubMed  Google Scholar 

  59. Fluker MR, Copeland JE, Yuzpe AA. An ounce of prevention: outpatient management of the ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:821–4.

    Article  CAS  PubMed  Google Scholar 

  60. Lincoln SR, Opsahl MS, Blauer KL, Black SH, Schulman JD. Aggressive outpatient treatment of ovarian hyperstimulation syndrome with ascites using transvaginal culdocentesis and intravenous albumin minimizes hospitalization. J Assist Reprod Genet. 2002;19(4):159–63.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Evbuomwan IO, Davison JM, Murdoch AP. Coexistent hemoconcentration and hypoosmolality during superovulation and in severe ovarian hyperstimulation syndrome: a volume homeostasis paradox. Fertil Steril. 2000;74(1):67–72.

    Article  CAS  PubMed  Google Scholar 

  62. Maslovitz S, Jaffa A, Eytan O, Wolman I, Many A, Lessing JB, et al. Renal blood flow alteration after paracentesis in women with ovarian hyperstimulation. Obstet Gynecol. 2004;104(2):321–6.

    Article  PubMed  Google Scholar 

  63. Grossman LC, Michalakis KG, Browne H, Payson MD, Segars JH. The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome. Fertil Steril. 2010;94(4):1392–8. doi:10.1016/j.fertnstert.2009.07.1662.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Abuzeid MI, Nassar Z, Massaad Z, Weiss M, Ashraf M, Fakih M. Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome. Hum Reprod. 2003;18(2):370–3.

    Article  CAS  PubMed  Google Scholar 

  65. Ozgun MT, Batukan C, Oner G, Uludag S, Aygen EM, Sahin Y. Removal of ascites up to 7.5 liters on one occasion and 45 liters in total may be safe in patients with severe ovarian hyperstimulation syndrome. Gynecol Endocrinol. 2008;24(11):656–8. doi:10.1080/09513590802342882.

    Article  PubMed  Google Scholar 

  66. Rinaldi ML, Spirtos NJ. Chest tube drainage of pleural effusion correcting abdominal ascites in a patient with severe ovarian hyperstimulation syndrome: a case report. Fertil Steril. 1995;63(5):1114–7.

    CAS  PubMed  Google Scholar 

  67. Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update. 2003;9(1):77–96.

    Article  CAS  PubMed  Google Scholar 

  68. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention ofthrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e691S–736. doi:10.1378/chest.11-2300.

    PubMed Central  CAS  PubMed  Google Scholar 

  69. Ando H, Furugori K, Shibata D, Harata T, Murata Y, Mizutani S. Dual renin-angiotensin blockade therapy in patients at high risk of early ovarian hyperstimulation syndrome receiving IVF and elective embryo cryopreservation: a case series. Hum Reprod. 2003;18(6):1219–22.

    Article  CAS  PubMed  Google Scholar 

  70. Vardhana PA, Julius MA, Pollak SV, Lustbader EG, Trousdale RK, Lustbader JW. A unique human chorionic gonadotropin antagonist suppresses ovarian hyperstimulation syndrome in rats. Endocrinology. 2009;150(8):3807–14. doi:10.1210/en.2009-0107.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  71. Abramov Y, Elchalal U, Schenker JG. Obstetric outcome of in vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril. 1998;70(6):1070–6.

    Article  CAS  PubMed  Google Scholar 

  72. Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet. 2002;267(1):4–6.

    Article  CAS  PubMed  Google Scholar 

  73. Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003;18(12):2599–602.

    Article  PubMed  Google Scholar 

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  1. Department of Reproductive Medicine, Central Manchester NHS Foundation Trust, St Mary’s Hospital, Oxford Road, Manchester, M13 9WL, UK

    Raj Mathur MD, FRFCOG

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    Raj Mathur

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Mathur, R. (2015). Ovarian Hyperstimulation Syndrome. In: Mathur, R. (eds) Reducing Risk in Fertility Treatment. Springer, London. https://doi.org/10.1007/978-1-4471-5257-6_3

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