Indications for Abdominal Surgery in Spontaneous Ovarian Hyperstimulation: A Literature Review

Objective: Ovarian hyperstimulation syndrome (OHSS) is a well-known phenomenon in reproductive medicine, complicating assisted reproduction for 1%-10% of women. When the same phenomenon occurs without ovulation induction, it is called spontaneous ovarian hyperstimulation syndrome (sOHSS). This extremely rare condition can be mistaken for other serious and more-prevalent conditions. There are algorithms proposed to guide the diagnosis. However, none of those algorithms include the role of surgical intervention to the best of our knowledge. This review of published literature on sOHSS evaluates the indications and types of abdominal surgical interventions in cases of sOHSS. Methods: A review of literature through medical electronic databases was carried out to describe the previously reported cases and the indications for abdominal surgical interventions in such cases until the end of 2016. Neonatal sOHSS cases were excluded. Results: Seventy-four cases were reported in 60 articles. The mean age of the women was 27 ± 6.96 years, with the youngest being 12 and the oldest being 40. One case had sOHSS in 4 consecutive pregnancies and another had it in her seventh pregnancy for the first time. Abdominal surgical intervention other than cesarean section was performed in one-third (20/74) of the patients. Suspicion of ovarian malignancy was the commonest indication for abdominal surgery in 55%. Other indications were management of suspected ovarian torsion or ovarian bleeding, therapeutic ascetic tap, and resection of ovarian tissue to decrease disease burden. Conclusions: sOHSS is a rare condition that needs to be kept in the differential diagnosis when the clinical picture is suggestive. The most-common indication for abdominal nonobstetric surgical intervention in such cases is suspicion of ovarian malignancy. When following the algorithms proposed for the diagnosis are not conclusive, conservative and principally diagnostic surgical intervention should be the approach.