Ovarian Hyperstimulation Syndrome: The Perils Of IVF

Women planning to undergo egg retrieval as a part of in vitro fertilization (IVF) should be informed of the risks involved. Ovarian hyperstimulation syndrome, or OHSS, is a potential side effect of ovarian stimulation. We will be discussing OHSS, its symptoms and ways to avoid this condition.

What is OHSS?

OHSS is an excessive response to the medications used to make eggs grow. OHSS may occur when a woman is administered injectable gonadotropins during the egg retrieval process. A woman usually ovulates one egg per month. When undergoing in vitro fertilization or egg retrieval, medications are prescribed to increase the number of eggs produced. These medications can cause the ovaries to swell, in turn leaking fluid into the abdomen and chest area.

What Are the Risk Factors of OHSS?

One major risk factor for OHSS is polycystic ovarian syndrome (PCOS). Women with PCOS who seek IVF treatment should be cautioned regarding the possibility of OHSS. Another risk factor is if the woman is younger than 35 years of age. Women with a low body weight and a large number of follicles may also be at a greater risk of developing OHSS. Additionally, during the egg retrieval process, your provider will likely evaluate your estradiol levels repeatedly. This is because a high or steeply increasing estradiol level prior to human chorionic gonadotropin (hCG) trigger may increase the risk for developing OHSS. Finally, women with a prior history of OHSS are at an increased risk of developing this condition a second time.

What Are the Symptoms of OHSS?

Some women who develop OHSS may notice symptoms as soon as a week after initiation of injections. In most cases, however, the symptoms take longer to develop. Most women who develop OHSS develop symptoms about a week after receiving the hCG trigger. Thus, it is important for women to continue to monitor their symptoms in the timeframe immediately following egg retrieval. Symptoms of OHSS include abdominal pain, abdominal bloating or increased waist size, diarrhea, nausea, vomiting and tenderness in the areas of the ovaries.

In severe cases of OHSS, a woman may experience rapid weight gain (more than 2.2 pounds in 24 hours). Additionally, severe abdominal pain, shortness of breath, decreased urination and a tight or enlarged abdomen may be signs of a severe OHSS. Women should be advised to contact their provider if these symptoms occur, as immediate medical attention may be warranted.

How Dangerous is OHSS?

It is important to be aware of the symptoms of OHSS, as severe cases of OHSS can be life-threatening. Complications of OHSS include kidney failure, fluid collection in the abdomen and chest, blood clots, ovarian torsion, electrolyte disturbances and severe bleeding from the rupture of an ovarian cyst.

How Do I Prevent OHSS?

There are several strategies that can decrease the likelihood of developing OHSS. During the stimulation process, your provider will likely perform serial ultrasounds to monitor your response to treatment. In order to decrease the chance of OHSS, your provider may elect to adjust your medication regimen. In some cases, a strategy known as “coasting” may be recommended. When coasting, providers will advise that you hold off on medications if your estrogen level is too high or if you develop too many follicles. Since hCG trigger shots are believed to increase the risk of OHSS, your provider may switch to an alternative type of trigger shot. In some cases in which a fresh embryo transfer is planned, your provider may recommend proceeding with frozen transfer instead, thus allowing your body to heal prior to transfer.

What Foods Should I Eat to Prevent OHSS?

Women who are at a higher risk of developing OHSS will often be advised to eat a high sodium and high protein diet following egg retrieval. Additionally, electrolyte-rich foods, such as sports drinks, are also often recommended. Following egg retrieval, women should be encouraged to avoid strenuous activity and drink plenty of fluids.

Takeaway Message:

OHSS is a potential risk of ovarian stimulation. Women who plan to undergo egg retrieval should be advised regarding the symptoms to look out for. Close monitoring during stimulation and after the egg retrieval process can help identify this condition. There are medical strategies that your provider can pursue to decrease the likelihood that you will develop this condition.

Have you been diagnosed with OHSS? What symptoms did you develop? Please share in the comments below. Please SUBSCRIBE to MamasConnected to stay up-to-date regarding all of your women's health questions.