Ovarian hyperstimulation syndrome (OHSS) refers to the amplified response of female hormones. This happens when injectable hormones are given to stimulate the ovaries. Mild cases of OHSS improve spontaneously, but severe cases require hospitalization.
What is Ovarian Hyperstimulation Syndrome?
The ovaries are the female internal reproductive organs that produce the eggs and the hormones estrogen and progesterone. The exact cause of ovarian hyperstimulation syndrome is not fully understood, but is associated with high levels of human chorionic gonadotropin (HCG). Ovarian blood vessels react abnormally to HCG and fluid begins to leak. This fluid inflates the ovaries and sometimes travels in large quantities to the abdomen. During fertility treatment, HCG is given as a “trigger” and mature follicles release eggs. OHSS usually occurs within a week of receiving an HCG injection. If you become pregnant during the treatment cycle, your body may begin to produce its own HCG as you become pregnant, which can exacerbate OHSS.
What are the symptoms of ovarian hyperstimulation syndrome?
Symptoms of ovarian hyperstimulation syndrome can be mild, moderate, or severe. Most women experience them within a week or two after injecting gonadotropins.
- Mild to moderate symptoms of OHSS
- Moderate abdominal pain
- Feeling full and full
- Nausea and vomiting
- Pelvic pain due to soft ovaries
In most women, mild ovarian hyperstimulation syndrome resolves spontaneously.
Severe symptoms of OHSS
- Rapid weight gain — over 2.2 pounds (1 kilogram) in 24 hours
- Severe abdominal pain
- Severe persistent nausea and vomiting
- Blood clot
- Reduced urination
- The abdomen is tight or enlarged
Severe forms of ovarian hyperstimulation syndrome require urgent hospitalization and medical examination.
When do I need to see a doctor?
If you are undergoing fertility treatment or are currently receiving hormone injections, look for the above symptoms, even if they are mild symptoms that require medical attention.
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How can I prevent ovarian hyperstimulation syndrome?
OHSS can affect all women taking fertility drugs, especially injectable hormones.
Here are some preventative strategies that the healthcare team can come up with:
- Your doctor may use the minimum dose of injection that can stimulate ovulation.
- Doctors may use alternatives that reduce the risk of OHSS without affecting the chances of getting pregnant. These include low doses of aspirin. Dopamine agonists such as carbergolin or quinogroid; and calcium infusion.
- Coasting. If estrogen levels are high or if a large number of follicles are developing, a doctor may stop the injection, wait a few days, and then administer HCG to cause ovulation. This is known as coasting.
- Avoid using HCG trigger shots. Since OHSS often develops after HCG trigger shots are given, HCG alternatives for triggers have been developed using Gn-RH agonists such as leuprolide.
- Frozen embryo. If you are undergoing in vitro fertilization, all follicles (mature and immature) may be removed from the ovaries to reduce the likelihood of OHSS. Mature follicles are fertilized and frozen, allowing the ovaries to rest. The in vitro fertilization process can be resumed at a later date.
What are the complications of ovarian hyperstimulation syndrome?
Complications occur primarily in severe cases of OHSS. They include:
- Moisture collection in the abdomen and possibly chest
- Electrolyte disorders (sodium, potassium, etc.)
- Large blood vessels, usually blood clots in the legs
- kidney failure
- Ovarian torsion (ovarian torsion)
- Rupture of ovarian cysts that can lead to severe bleeding
- Breathing problems
- Miscarriage due to complications or loss of pregnancy due to retirement
- Rarely, death
What are the treatment options for ovarian hyperstimulation syndrome?
Mild OHSS can be resolved naturally. Moderate and severe treatment options are:
- Treatment of moderate OHSS
- Proper intake of water
- Visit to medical facilities for timely physical examination and ultrasound
- Measure waistline and weight to track immediate changes
- Record urine flow and volume
- Blood tests to monitor dehydration, electrolyte imbalances, and other problems
- Use a needle inserted into the abdominal cavity to drain excess ascites
- Drugs that prevent blood clots (anticoagulants)
Treatment options Severe OHSS
Severe OHSS may require hospitalization for monitoring and aggressive treatment, including infusion. Your doctor may give you a cabergoline drug or a drug called a gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole to help suppress ovarian activity.
Serious complications may require additional treatment, including surgery for ruptured ovarian cysts and intensive treatment for liver and lung complications. Anticoagulants may also be needed to reduce the risk of blood clots in the feet.
Ovarian hyperstimulation syndrome is a condition in which injectable hormones can cause damage to the body. Mild OHSS symptoms may not require hospitalization. There are several strategies doctors can adopt to prevent the development of ovarian hyperstimulation syndrome. If OHSS is getting worse, your doctor may recommend freezing the embryo. It allows you to receive IVF at a later stage with a more important chance of success.
Frequently Asked Questions (FAQ)
How common is OHSS?
Women with polycystic ovary syndrome are at increased risk of developing OHSS. Mild OHSS can be resolved on its own and can occur in about a quarter of patients. Severe or severe OHSS is rare.
When do you recover from ovarian hyperstimulation syndrome?
Most women with mild OHSS recover within 1-2 weeks of the onset of symptoms. In some cases, the doctor freezes the embryo and continues in vitro fertilization when the body is ready.
What is OHSS’s specific home care strategy?
- For abdominal discomfort, try over-the-counter painkillers such as acetaminophen. However, if you have recently had an embryo transfer, avoid ibuprofen or naproxen sodium. These drugs can interfere with embryo implantation.
- Avoid sexual intercourse as it can be painful and the cysts of the ovaries can rupture.
- Maintain light physical activity levels, avoiding intense or high-impact activities.
- Weigh the same weight daily, measure around the abdomen and report any abnormal increase to your doctor.
- Contact your doctor if any signs or symptoms worsen.