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Preventing severe OHSS has many different facets

      Only 20 years ago we had no understanding of what causes OHSS. The review by Soares (
      • Soares S.R.
      Etiology of OHSS and use of dopamine agonists.
      ) chronicles a remarkable story defining granulosa cell (GC) VEGF as the mediator of this syndrome, culminating in treatment with dopamine agonists that block VEGF receptor expression as the cause of increased vascular permeability. I was fortunate to be part of an elegant study by Levin and colleagues (
      • Levin E.R.
      • Rosen G.F.
      • Cassidenti D.L.
      • Yee B.
      • Meldrum D.
      • Wisot A.
      • et al.
      Role of vascular endothelial cell growth factor in ovarian hyperstimulation syndrome.
      ) using a bioassay for vascular permeability showing that 98% of the bioactivity of follicular fluid in high responders was blocked by an anti-VEGF antibody. Other purported mediators of the syndrome must therefore play a very limited role.
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