False about OHSS?
Correct Answer: The symptoms associated with OHSS usually begin 15-20d after hCG is given
Description: Ans. D. The symptoms associated with OHSS usually begin 15-20d after hCG is givenOvulation induction promotes follicle maturation and oocyte release utilizing pharmacological agents. The most commonly used agent is Clomiphene citrate, which increases follicle-stimulating hormone release at the level of the hypothalamus. It is usually given for 5d during the mid-follicular phase and ovulation occurs l-10d following the final dose. Alternative ovulation induction agents include metformin and gonadotrophins.Transvaginal US is used to track the development of follicles and the endometrial thickness so that the dose of the agent can be titrated and intercourse or insemination can be correctly timed to coincide with ovulation. Although the maturity of the oocyte can only be indirectly inferred from the size of the follicle, the US information can be coupled with oestradiol values to provide an accurate assessment of the presence or absence and number of mature follicles. It is important to look for the complications of ovulation induction such as hyperstimulation. This occurs most commonly in gonadotrophin-induced cycles. The ovary becomes enlarged, sometimes massively so, and oedematous, containing multiple immature follicles. Abdominal ascites may also be demonstrated. The hyper stimulated ovaries are prone to torsion. The signs and symptoms of ovarian hyperstimulation disorder are variable, ranging from mild abdominal discomfort, probably due to the distension of the ovarian capsule, to severe circulatory compromise and electrolyte imbalance. The more severe form, ovarian hyperstimulation syndrome (OHSS), is usually associated with massive stromal oedema of the ovary. The enlarged ovaries may be prone to torsion. On US, patients with OHSS usually have enlarged ovaries (>10cm) that may contain several hypoechoic areas. The hypoechoic areas may correspond to atretic follicles or to regions of hemorrhage within the ovary. The symptoms associated with OHSS usually begin 5-8d after hCG is given, but they can be most severe in patients who actually achieve pregnancy. Recent studies have shown that hyperstimulation is unlikely in women whose ovaries contain several large (>15mm) follicles, and tends to occur when there are several small or intermediate-sized follicles. With supportive therapy, this syndrome usually regresses spontaneously.
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Gynaecology & Obstetrics
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