Ovarian Hyperstimulation Syndrome (OHSS): A Downside Of Using Fertility Drugs

Excessive stimulation of the ovaries is called ovarian hyperstimulation caused primarily due to reaction to fertility drugs taken by the  patient. About one in three women having IVF develop mild OHSS.

Most cases of OHSS are mild, but severe cases can be dangerous due to the risk of serious complications. OHSS can affect you whether you are taking fertility drugs for IVF, IUI, or have opted for egg donation.

If you’re having IVF, severe OHSS can be a sign that you are pregnant. When you’re pregnant, your body starts to produce human chorionic gonadotrophin (hCG), a hormone used in fertility treatment. This hormone tells your ovaries to release your mature eggs into your fallopian tube. It may take up to 10 weeks for the symptoms to resolve if you are pregnant.

 If your doctor has prescribed human menopausal gonadotrophin (hMG) as your fertility drug, your clinic will monitor you closely. Taking hMG prompts your ovaries to produce several eggs. But this drug carries a high risk of OHSS if you are also given the hormone hCG. So, withholding hCG is recommended if you have a high risk of OHSS.

Risk Factors

You have a greater risk of developing OHSS if you:

• are young (under 35)
• have polycystic ovary syndrome (PCOS)
• have had OHSS before

If you have a high risk of developing OHSS, your doctor will adjust your treatment to try to prevent this from happening.

Signs & Symptoms

SIGNS AND SYMPTOMS WHY IT HAPPENS WHAT TO DO Mild You may experience: – Abdominal bloating and feeling of fullness – Nausea – Diarrhea – Slight weight gain This may be due to: – Ovaries are larger than normal, tender and fragile – High level of estrogen (E2) and progesterone in the bloodstream may upset your digestive system and fluid balance causing bloating. Recommended treatment: – Avoid sexual intercourse – Do not have a vaginal (pelvic) exam other than by one of our physicians – Reduce activities, no heavy lifting, straining or exercise – Drink clear fluids, flat coke, ginger ale, cranberry juice, Gatorade or Ensure Moderate You may also experience: – Weight gain of greater than 2 lbs. per day (excessive weight gain) – Increased abdominal measurement causing clothes to feel tight – Vomiting & diarrhea – Urine is darker and amount is less – Skin/hair may feel dry – Thirst This may be due to: – High levels of hormones in the bloodstream upset the digestive system – Fluid imbalance causes dehydration because body fluids collect in the abdomen and other tissues – This fluid collection causes severe bloating As noted above plus: – Call our nurses – You may need to be seen by a physician who will do an ultrasound – Record your weight twice daily – Record the number of times you urinate each day- Severe You may also experience: – Fullness/bloating up above the belly button – Shortness of breath – Urination has reduced or stopped and become darker – Calf pains and chest pains – Marked abdominal bloating or distention – Lower abdominal pain This may be due to: – Extremely large ovaries – Fluid collects in lungs and/or abdominal cavity, as well as in tissues – The risk of abnormal blood clotting increases As noted above plus: – Notify the physician on call – You may need to be assessed at the hospital or our clinic – Excess fluid may need to be removed from your abdominal cavity

Table source: http://www.ivf.com/

Personal Management Tips:

• drink water when you’re thirsty
• take painkillers, such as paracetamol or codeine
• move your legs regularly to reduce your risk of blood clots

Don’t drink excessive amounts of water or take anti-inflammatory painkillers, such as aspirin or ibuprofen, as these will affect your kidneys.

Note: Do not exercise too strenuously or have sex, while you have OHSS, as this may damage your swollen ovaries further.