I saw my 2nd case this year of renal effects of Ovarian Hyperstimulation Syndrome (OHSS).OHSS is a complication of in vitro fertilization therapy, in which pharmacologic doses of gonadotropin therapy can lead to enlarged ovaries filled with multiple cysts, the result of multiple follicles maturing simultaneously. The follicles release multiple growth factors (e.g. VEGF) which increase capillary permeability, often resulting in massive ascites, weight gain, and volume overload. In both cases I have been consulted on, the patients have had significant intravascular volume depletion and hypovolemic hyponatremia as a result of significant 3rd-spacing.
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