Von der Pathophysiologie und Prävention des ovariellen Überstimulationssyndroms (OHSS) bis zur stadiengerechten Therapie

Zusammenfassung

Das schwere ovarielle Überstimulationssyndrom (OHSS) kompliziert 0,3 - 5 % der Zyklen kontrollierter ovarieller Stimulation im Rahmen assistierter reproduktiver Techniken (ART). Obwohl die Ursachen des OHSS nicht endgültig geklärt sind, löst das zur Ovulationsinduktion gegebene HCG oder die endogene HCG-Produktion beim Eintritt einer Schwangerschaft das OHSS aus. Es erfolgt eine vermehrte Neoangiogenese und erhöhte Kapillarpermeabilität im Bereich der Ovarien, so dass es lokal zu einem vermehrten Flüssigkeitsübertritt aus den Ovarien in die Bauchhöhle als Aszites kommt, beim schweren OHSS verläuft die Erkrankung durch die erhöhte Gefäßpermeabilität meist systemisch. Die wichtigsten Faktoren, die auf zellulärer Ebene für das Entstehen eines OHSS verantwortlich gemacht werden, sind das Angiotensin-Renin-Aldosteron-System, Zytokine (IL-1, IL-2, IL-6, IL-8), der Tumornekrosefaktor alpha (TNF-α) und in zentraler Rolle der Vascular endothelial growth factor (VEGF). Da in supprimierten Stimulationszyklen die Ovulationsinduktion derzeit nur mit HCG ausgelöst werden kann, lässt sich das OHSS trotz verschiedener Ansätze der Prävention nicht komplett vermeiden. Deshalb möchten wir in dieser Arbeit eine Übersicht der stadienadaptierten Therapie vorstellen.

Abstract

Severe ovarian hyperstimulation syndrome (OHSS) complicates 0.3 - 5 % of controlled ovarian stimulation cycles for assisted reproductive techniques (ART). Although the reasons for OHSS still remain enigmatic, HCG either applicated for ovulation induction or produced by the trophoblast is the most important trigger for developing OHSS. Enhanced neoangiogenesis and capillary permeability in the ovaries cause a third space fluid shift which locally results in ascites or pleural effusion reflecting systemic severe OHSS. The most important factors which are involved in the development of OHSS on the cellular level are the angiotensin-renin-aldosteron-system, cytokines (IL-1, IL-2, IL-6, IL-8), tumor necrosis factor alpha (TNF-α) and of central importance vascular endothelial growth factor (VEGF). As OHSS cannot completely be prevented in down-regulated stimulation cycles, this article can be regarded as a guideline for adequate therapy strategies depending upon the grade of OHSS.

Schlüsselwörter

OHSS - Prävention - Therapie - Kapillarpermeabilität - Zytokine

Key words

OHSS - Prevention - Therapy - Capillary permeability - Cytokines

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