KOMPLIKATIONEN DER GONADOTROPINTHERAPIE

All complications of gonadotropin treatment are essentially due to ovarian stimulation, follicular development and luteinisation or ovulation. To the best of our knowledge direct side-effects to the drug itself have not been reported. The main complications of gonadotropin therapy are: 1. high incidence of multiple pregnancy. 2. Ovarian Hyperstimulation Syndrome (OHSS). Ovarian hyperstimulation, the most serious complication of HMG/hCG treatment, is a potentially life-threatening, iatrogenic disorder. The syndrome occurs when treatment with ovulation inducing drugs (HMG, Gonadotropin Releasing Hormones or clomiphene) results in the growth of multiple large follicles followed by the development of follicular and corpus luteal cysts. The enlarged, cystic ovaries are associated with increased capillary permeability, drainage and fluid transfer from the intravascular compartment to the peritoneal and pulmonary cavities. This will be expressed by weight gain and variable degrees of ascites and hydrothorax. The resulting symptoms, e.g. thrombo-embolic phenomena, are caused directly by increased haemoconcentration and hypovolemia (in turn causing decreased renal perfusion) and are secondary results of increased peritoneal pressure. A comprehensive classification of hyperstimulation is outlined and its possible prevention is discussed. Modern approach to monitoring and treatment of hyperstimulation should it occur is described in detail.