Severe OHSS: An 'epidemic' caused by doctors.

Assisted reproductive techniques (ART) are elective procedures in otherwise healthy patients. Therefore any complication occurring during treatment is iatrogenic. Sadly, the most serious and potentially life threatening complication, the ovarian hyperstimulation syndrome (OHSS) still frequently occurs. Abramov et al. (1999) report an increase in the incidence of OHSS and state that we are facing an epidemic of severe OHSS. The authors state that the increasing incidence of severe OHSS reflects two trends: in the first place an increase of popularity of ART explains the rising number of in-vitro fertilization (IVF) treatments carried out. Apparently, IVF is used more liberally to solve problems in infertility. With the higher success rates per cycle reported an increase in the number of cycles indicates an even higher increase in the number of couples entering IVF programmes. Considering expenses, possible complications and discomfort for the patients IVF should only be utilized when all other treatment modalities have no change of success or have failed. One can seriously wonder whether the criteria for the application of ART are used strictly enough. The second trend mentioned by the authors is the more liberal use of ovulation induction medications. Indeed there