The cascade of events that leads to the development of ovarian hyperstimulation syndrome (OHSS) is almost always accompanied by elevated estradiol (E(2)) levels. The role of estrogen level in OHSS has not been confirmed; however, it was shown repeatedly in the literature that elevated levels of E(2) constitute a risk for OHSS. Monitoring E(2) was found to be effective in reducing the incidence of OHSS. It was also reported that reducing the E(2) level by coasting helps to prevent OHSS. It is believed that irrespective of the debatable role of estrogen in the pathogenesis of OHSS, there is a general agreement that E(2) assay is an important marker to detect the majority of patients at risk of OHSS.
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