OHSS is a potentially serious complication of ovarian stimulation with exogenous gonadotrophins. The risk of serious disease is much higher when exogenous gonadotrophins are employed. In women with the disorder, transvaginal or transabdominal ultrasonography often demonstrates grossly enlarged ovaries containing numerous large follicular cysts with thin, highly echogenic borders, and dramatically increased local blood flow (38). The ovaries may enlarge to diameters in excess of 10 cm, and echotexture interpreted as intrafollicular hemorrhage in some of the large cysts frequently may be observed. Serial TVUS during ovarian stimulation cycles and careful tailoring of the dose of exogenous gonadotrophins has helped to limit the risk of OHSS (38,39). Clinicians take an active role in the prevention of OHSS by aborting the treatment cycle and cryopreserving the embryos for later, or replacement of a single embryo when excessive numbers of pre-ovulatory follicles develop in association with markedly elevated serum estradiol concentrations and the risk of OHSS is high (40). When OHSS does occur, torsion of an enlarged ovary is a complication that must be kept in mind. When torsion is suspected, color flow Doppler imaging can help to establish an early and accurate diagnosis (41,42).
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