Diagnosis, prevention and management of XXXX .

@entity1 @entity43 @entity14563 @entity3610 @entity1420 @entity548 @entity649 @entity1150 @entity810
The overall incidence of clinically important (moderate to severe) @entity14563 ranges from 1% to 10% of IVF cycles, but only a small proportion (0.5% to 2%) of the cases are severe. In extreme but rare cases, secondary complications such as @entity1150 , @entity649 and @entity810 may occur. The main risk factors are the presence of @entity3610 , high ovarian response to superovulation therapy, the use of hCG to trigger the ovulatory process or for luteal phase support, and the endogenous production of hCG by an early pregnancy. The pathogenesis of @entity14563 is unknown, although the predominant biochemical mediator is thought to be the renin-angiotensin system. Ovarian stimulation should always be carefully monitored to identify those @entity1 at risk. In IVF cycles, the hCG injection should be withheld if the risk is judged to be too great. Some @entity1 will benefit from a policy of proceeding to collect oocytes, but electively cryopreserving any resulting embryos, thus allowing the ovarian stimulation cycle not to be wasted. The administration of albumin at the time of oocyte collection will reduce the chance of severe @entity14563 occurring. If a decision is made to proceed with oocyte recovery and embryo transfer, it may be advisable to give 5000 IU of hCG, rather than 10,000 IU, as the ovulatory trigger. @entity1420 , and not hCG, should be given in the luteal phase. @entity1 developing mild or moderate @entity14563 should be kept under outpatient surveillance to detect the minority that may progress to severe @entity14563 . Those with severe @entity14563 should be hospitalised for fluid and electrolyte management. Paracentesis under ultrasound guidance is recommended where there are tense ascites, but further surgical intervention should rarely be undertaken and only when there is good clinical evidence of @entity43 or @entity548 .
