Polycystic Ovary Syndrome is the most common hormonal disorder that occurs in modern Western societies. It is estimated that one in ten (1/10) women will experience this syndrome, characterized by menstrual cycle disturbances – an increase in androgens and disturbances in insulin metabolism. As a result, these women do not: Ovulate (infertility) and also have irregular cycles. They show insulin resistance and therefore type 2 diabetes mellitus and finally show acne – hirsutism (hypertrichosis) as well as increased skin oiliness and in extreme cases loss of the scalp (male pattern alopecia)

Polycystic ovary syndrome is one of the most frequent causes of infertility, it can appear as early as adolescence and are largely responsible for the appearance of long-term diseases, as we mentioned above, with organic and psychological effects.
Type 2 diabetes, high blood pressure, elevated LDL cholesterol, weight gain, anxiety, depression and low self-esteem often have serious effects on the health of the affected woman.

Rationale

Despite the great progress in the diagnosis and treatment of the syndrome in the last fifty years, the etiology of its occurrence remains complex and not fully understood. It can be linked to dysfunction of the hypothalamus, pituitary gland, ovaries and even adrenal glands. Genetic contributions also appear to exist.

It is therefore easy to understand that in dealing with the syndrome, the cooperation of many specialists is necessary, such as a gynecologist, an endocrinologist, a nutritionist, a psychologist-psychiatrist, etc. (a holistic approach to the patient).
However, it is a common phenomenon that these treatments are not enough for women to conceive naturally, so in vitro fertilization (IVF) comes to help in these cases.

Special protocols are used and very close monitoring of the process with frequent ultrasounds and hormone determinations, to avoid overstimulation of the ovaries.

We usually use LHRH antagonists, from the first day of stimulation, but in any case the individualization of the treatment according to the hormonal profile and the response of the patient is considered to improve the results.

Polycystic ovary syndrome is characterized by the presence of multiple follicles that are in an early phase of development. Although the exact pathophysiology is not elucidated, it appears that these follicles can mature en masse when exposed to exogenous gonadotropins.

Most common complication of stimulation for IVF is ovarian hyperstimulation. In the pathogenesis of Ovarian Hyperstimulation Syndrome (OHSS), disorders of the ovarian renin-angiotensin system and mainly of the Vascular Endothelial Growth Factor (VEGF) have been implicated. Research data converges on the view that VEGF, a substance that normally promotes endothelial cell proliferation and angiogenesis, may also cause increased permeability of the endothelium through a No-dependent mechanism, but also the scheduled administration of human chorionic gonadotropin (hCG) is directly related to the occurrence of SIO.

There are several stages of ovarian hyperstimulation that are divided according to the severity of the symptoms:

I. Mild stimulation: mild bloating, slight abdominal pain and mild weight gain lasting about a week after ovulation.

II. Moderate irritation: increased bloating, nausea, vomiting, abdominal pain, weight gain up to 4 kg. They last about ten days and require medical attention.

III. Severe overstimulation: severe abdominal pain, weight gain of more than 4 kg, decreased urination, fluid in the abdomen and chest. He definitely needs hospitalization. The swelling of the ovaries reaches up to 20-25 cm, causing pain, nausea and vomiting.

IV. Ascites: with intense distension of the abdomen occurs due to extravasation and increased leakage of proteinaceous fluid from the intravascular space into the intraabdominal cavity, due to a difference in osmotic pressure and increased vascular permeability in the area around the ovaries and their vascular network. The administration of hCG plays a decisive role in the activation of this process.

V. Peritonitis: the irritation of the peritoneum due to the inflammatory substances released, the blood from the cysts and the proteinaceous fluid cause the following:

 Intense abdominal pain, while rupture of the cysts or twisting of the ovaries is possible.
 Hypotension and hypoglycemia, due to a large development of edema, ascites and hydrothorax with reduced cardiac output and hypotension.
 Dyspnea also due to extravasation (pleural effusion pulmonary edema – pulmonary embolism and pericardial effusion).

VI. Blood hypercoagulability. The resulting hemoconcentration and hypoglycemia and elevated estrogen levels cause hypercoagulability of the blood resulting in venous thrombosis and hence pulmonary embolism.

VII. Electrolytic disorders and acute renal failure. The reduced perfusion of the kidney causes renal dysfunction, electrolyte disturbances with hyperkalemia and acidosis.

The treatment of SIO depends on the severity of the symptoms (stage). Careful outpatient monitoring, rest, hydration and information are sufficient for mild symptoms. Embryo transfer is also not carried out because the patient will be burdened.

In more severe cases, inpatient hospitalization and perhaps in an ICU unit should be recommended for strict monitoring and appropriate treatment of the resulting problems.