What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)Dr. Ashish Kale
Complications from fertility treatments are rare; nevertheless, some people do experience side effects. Anyone undergoing ovarian stimulation is at risk of developing ovarian hyperstimulation syndrome (OHSS), one of the most serious side effects of fertility treatments. Because if this, It’s to your advantage to be informed and on the lookout for symptoms to bring to your doctor’s attention.
What is OHSS?
OHSS is irritation of the ovaries that can happen when they are stimulated to produce a lot of eggs at once. OHSS is caused by high levels of estrogen in the bloodstream, which causes the ovarian blood vessels to become leaky to fluids. This means fluids leave the bloodstream and collect in the abdominal cavity.
Even though a woman with OHSS drinks plenty of fluids, she can become severely dehydrated. As a result, the blood becomes thickened leaving her at risk for blood clots in the legs and lungs.
What are the Symptoms of OHSS?
The symptoms of OHSS may be mild, moderate, or severe and usually begin four to five days following egg collection. The accumulation of fluid in the abdominal cavity can be very uncomfortable and cause bloating, sometimes breathlessness. In severe cases, the fluid enters the lungs and causes respiratory distress.
- Mild abdominal pain
- Abdominal bloating and weight gain
- Mild nausea
- Tenderness around the ovaries
Moderate to Severe OHSS
- Rapid weight gain
- Severe abdominal pain
- Persistent nausea and vomiting
- Decreased urinary frequency
- Dark urine
- Shortness of breath
- Tight and enlarged abdomen
Who is at risk?
Some women are more at risk than others of developing this complication. Women with polycystic ovaries are most at risk because they have many tiny follicles present that Respond to the stimulation medicine. Other women at risk are those who have a high number of antral follicles, high anti-mullerian hormone (AMH) levels, high luteinizing hormone (LH) blood level and high LH to follicle-stimulating hormone (FSH)ratio.
An individual’s risk should be assessed by a doctor ahead of starting an IVF cycle to adjust the starting dose of stimulation medication accordingly. Additionally, the doctor will do regular ultrasound scans of the ovaries during the stimulation phase and monitor the circulating estrogen levels as they rise.
If the blood estrogen level is rising too high or too quickly, the doctor can reduce the dose of FSH medication or “coast” the treatment by stopping the FSH injections for a few days. This will give the ovaries a break from being over-stimulated and help to reduce the chance of OHSS.
How common is OHSS?
Mild OHSS occurs in around 30% of all treatment cycles and is considered a normal side effect of ovarian stimulation for IVF. The symptoms are easily managed with over-the-counter painkillers, dietary changes, and increased fluid intake.
Severe OHSS affects around 3 to 8% of cycles and is managed well with medical help.
Clinical Treatment of OHSS
For more severe cases, the following may be required:
- Cancellation of embryo transfer until a later date
- Prescription anti-nausea medication
- Drain excess fluid from the abdomen with a needle puncture, similar to an egg retrieval
- Administer intravenous fluids
How can OHSS be prevented?
Prevention is better than cure, and your doctor should monitor the stimulation phase of the IVF cycle carefully. Ultrasounds and blood tests measure the ovaries’ response to the stimulation drugs.
The dose will be lowered if the estrogen levels become too high or you may take a break from injections for a day or two. It is better to start with a lower dose and add extra FSH during ovarian stimulation than start too high and be at risk for complications. If the ovarian response is extremely high the doctor might choose to cancel the cycle altogether and start again with a lower dose next time.
If you’re having the trouble, Dr. Ashish Kale will help you figure out why, and work with you to find a treatment that can help. He is one of the best Gynaec Endoscopy Surgeon, IVF Specialist in Pune & currently practicing at Ashakiran hospital which is one of the best Infertility Center in Pune.
Dr. Ashish Kale should be able to choose the best treatment regimen for you that minimizes the chance of complications while maximizing the treatment outcome.