ULTRASOUND IN THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF OVARIAN HYPERSTIMULATION SYNDROME IN BAMAKO

Ovarian hyperstimulation or ovarian hyperstimulation syndrome (OHSS) is a direct complication of in vitro fertilization with heavy morbidity and, in some cases, even mortality. The physiology remains poorly defined but seems to be moving towards a cascade activation of coagulation through the vascular endothelial growth factor (VEGF). There are patient-specific or pacing-specific risk factors, but this complication can occur in the absence of these factors. Two types can be described: early OHSS linked to the onset of ovulation and late linked to pregnancy. The management is poorly defined and must adapt to the severity of OHSS by taking care of the added complications.The major complication is thrombotic with the particularity of affecting both the venous and arterial territories, which can induce serious complications such as strokes or myocardial infarction. Prevention of this thrombotic risk therefore remains the priority of OHSS management. Since few studies have been carried out on this subject, we have shown here the place of ultrasound in the prevention, diagnosis and treatment of ovarian hyperstimulation syndrome. Aims: - Identify the risk factors of OHSS. - Describe the sonographic signs of OHSS. - Show the role of the radiologist/sonographer in the management of OHSS. Subjects And Methods: This was a cross-sectional, descriptive study concerning 350 women collected between March 2018 and March 2022 in different medically assisted procreation centers in Bamako. The study population consisted of consenting women presenting for assisted reproduction assessment in whom risk factors, signs of hyperstimulation and even complications were identified. The risk factors were: high anti-Müllerian hormone (AMH), the young age of the patient and the count of antral follicles (AFC) with more than 14 follicles. The patients had a biological assessment, the ultrasounds were made by endo-cavitary way and by high way with devices of General electric Voluson E8, Vivid 3 and Logic9. Results: 350 women were recruited into our. The average age was 26 years with extremes ranging from 18 to 37 years. 60.85% of the patients were between 18 and 25 years old. The risk factors were: high anti-Müllerian hormone (AMH) (7%), the young age of the patient (88%) and the count of antral follicles or AFC>14 follicles (89.8%). The clinical signs of OHSS were abdominal distension (8.5%), abdominal pain (8.5%), nausea and vomiting (2.28%). Ultrasound signs, i.e. ascites, increased ovarian volume, presence of large ovarian follicles were present in 8.57% of patients. The number of punctured follicles varied between 10 and 30. In sum, hyperstimulation was recorded in 30 patients, i.e. 08.57% of the 30 patients who had the OHSS, 12 had a pregnancy. Conclusion: There are risk factors for OHSS that correspond to patients with good or even excessive ovarian reserves, as in the context of polycystic ovary syndrome. However, OHSS occurs in 33% of cases with no identified risk factor [1]. It is therefore advisable to carefully monitor ovarian stimulation in the context of In Vitro Fertilization with doses adapted to the patients and to remember that the best prevention remains the cancellation of the cycle without triggering or coasting, that is i.e. a cessation of gonadotropins. OHSS is a serious complication of PMA that can be life-threatening, so care and monitoring must be rigorous, adapted to each stage of the disease. The great variability of OHSS makes it difficult to draw up recommendations for clinical practice and it is therefore necessary to adapt the management according to each patient.