A potentially dangerous side effect of in vitro fertilization procedures using injectable fertility drugs is ovarian hyperstimulation syndrome (OHSS). These drugs, called gonadotropins, are used to induce multiple mature egg production in the ovaries in preparation for assisted reproductive technologies such as in vitro fertilization (IVF). Although producing several high-quality eggs is the target, overstimulating the ovaries can occasionally result in OHSS.
The enlargement of the ovaries and a buildup of fluid in the abdomen and occasionally chest cavities are the hallmarks of OHSS. Many irritating and sometimes harmful symptoms may result from this. Anyone undertaking ovarian stimulation-based reproductive therapies needs to understand the reasons for, risk factors, symptoms, and treatment of OHSS.
Symptoms of OHSS:
The severity of the illness affects the signs and symptoms of OHSS. While symptoms can take up to two weeks to manifest, they usually start one week after taking medicine to induce ovulation.
Mild to moderate OHSS symptoms include:
Abdominal pain.
Bloating.
Weight gain (more than 2 pounds per day).
Nausea and vomiting.
Diarrhea.
Decreased urination.
Shortness of breath.
Rapid heart rate.
In more severe cases of OHSS, symptoms may include:
Excessive weight gain.
Severe nausea and vomiting.
Severe abdominal swelling.
Difficulty breathing.
Decreased urination.
Severe abdominal pain.
What Causes OHSS?
Most of the time, OHSS results from your ovaries being stimulated by the hormone HCG, or human chorionic gonadotropin. Hormone treatments cause your ovaries to create many eggs at once, even though they normally only produce one egg at a time. A "trigger shot" of HCG is frequently given to patients undergoing fertility treatments to aid in egg maturation prior to the IVF egg retrieval procedure. People who create a large number of prospective eggs may experience an overactive response from their ovaries to this medicine, which could lead to OHSS.
Risk Factors for OHSS:
Certain factors can increase a woman's risk of developing OHSS during fertility treatments:
Young age: Women under 30 are at higher risk.
Polycystic ovarian syndrome (PCOS): Women with PCOS are more prone to ovarian hyperstimulation.
High Anti-Müllerian hormone (AMH) levels: High AMH is associated with increased ovarian response.
History of OHSS: Women who have experienced OHSS in the past are at greater risk.
High ovarian response: Producing an unusually high number of follicles during stimulation.
High estrogen levels: Estrogen levels over 3,000-4,000 pg/mL increase OHSS risk.
How does one diagnose ovarian hyperstimulation syndrome (OHSS)?
Multiple tests are used by medical professionals to diagnose OHSS. These examinations may consist of:
Physical examination: To look for symptoms of swelling, the healthcare provider weighs you and measures your waist measurement. Because your ovaries are enlarged and could explode under direct pressure, a pelvic check is not advised.
Ultrasound: Measures the size of your ovaries, the amount of free fluid in your belly (abdomen).
A chest X-ray searches your chest for fluid.
Blood test: Checks for OHSS symptoms by measuring your hormone levels.
Preventing OHSS:
Certain OHSS cases are unavoidable. Your medical professional will, however, be able to determine your risk level based on your blood tests and medical history. In order to lower your risk of OHSS during fertility treatments, your doctor may frequently examine your ovaries using blood tests (to check hormone levels) and ultrasounds (to look at how many follicles are forming).
The following are some ways your team can lessen symptoms or avoid OHSS:
Lowering or changing the dosage of your reproductive medication.
Avoiding an HCG "trigger shot" while undergoing therapy.
Modifying the fertility drug.
Preserving your embryos in the freezer and postponing their transfer till the ovaries recover normally.
Treating OHSS:
For mild to moderate cases of OHSS, treatment usually involves:
Avoiding vigorous physical activity.
Drinking electrolyte-rich fluids such as Gatorade.
Using acetaminophen to relieve symptoms.
Weighing yourself daily.
Monitoring yourself for any severe symptoms.
Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include:
Receiving intravenous (directly into the vein) fluids.
Undergoing paracentesis (a procedure to remove fluid from your belly).
Taking medicines to ease symptoms or reduce activity in your ovaries.
A blood thinner to help decrease the risk of a blood clot.
The severity of the problem determines the course of treatment for OHSS. The goal of treatment is to control symptoms and prevent side effects. Mild instances usually clear up in a week or two. But, your symptoms can persist for a lot longer if you become pregnant during that cycle.