A 31-year-old woman undergoing controlled ovarian stimulation for IVF received hCG trigger 9 days ago. She now presents with progressive abdominal distension, severe nausea, vomiting, reduced urine output, and dyspnea. Examination reveals tense abdominal distension with shifting dullness, bilateral basal crackles, hypotension (96/64), tachycardia (116 bpm), hematocrit 53%, WBC 22,000, creatinine 1.6 mg/dL, and hyponatremia. Ultrasound shows the structure marked **A** measuring >12 cm bilaterally with multiple large cysts in a wheel-spoke pattern, along with ascites and pleural effusions. Which of the following best explains the pathophysiology of the severe manifestations in this patient?
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