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Ovarian Hyperstimulation Syndrome

What is Ovarian hyperstimulation syndrome (OHSS) and its cause?

OHSS is a manageable complication that might occur during infertility treatment mainly IVF. Usually ovaries are stimulated with medications (Clomiphene citrate or gonadotropin-releasing hormone) to make egg grow during infertility treatment further might lead to OHSS. Only 1 % – 10 % of such women population develops OHSS. It is characterized by:

  • Ovarian enlargement with the release of chemicals into bloodstream

  • Fluid from blood vessels leak and accumulation into abdomen

  • Formation of blood clot in blood vessel

What are the sign & symptoms of OHSS?

Sign & symptoms of OHSS may vary from mild to severe are

Range

Sign & Symptoms

Mild

Mild abdominal swelling

Abdominal bloating

Abdominal discomfort

Mild abdominal pain

Moderate

Moderate abdominal pain

Nausea and or vomiting

Diarrhoea

Minor weight gain

Abdominal swelling increases due to fluid accumulation in the abdomen

Severe

Excessive thirst

Dehydration

Urine output decreased

Difficulty in breathing as fluid accumulated in chest

Abnormally low level of protein in the blood

Weight gain

Formation of clot in the leg or lung

Redness and tenderness in legs

Who are at risk of developing OHSS?

  • Women have PCOD

  • Young women (Under 30 years)

  • Women had history of OHSS

  • Women have successful IVF with multiple pregnancy

  • Thin women

  • High serum estradiol (E2) concentrations during ovarian stimulation

  • A rapid rise in serum E2 during ovarian stimulation

  • Elevated follicles & egg numbers

What is the treatment of OHSS?

There is as such no cure available for OHSS but the symptomatic relief can always be provided. Mild to moderate symptoms of OHSS can be easily manage at home while severe OHSS symptoms patient might require hospitalization at times. Management of OHSS symptoms included:

Criteria for Symptoms

Management

Mild to moderate

Take OTC painkillers such as paracetamol or codeine. Avoid non-steroidal anti-inflammatory agents

Drink lot of fluid to relieve thirst

Take anti-sickness drugs to stop nausea and or vomiting

Severe

Intravenous drip to reduce dehydration

Take painkillers and anti-sickness drugs

Use stockings and administrated anti coagulation injections (heparin) to avoid blood clots formation in the blood vessels and lungs

If a large amount of fluid accumulated in abdomen then paracentesis procedure needed to be performed by infertility specialist. In this procedure, infertility specialist removed the fluid from abdomen with the help of thin needle/tube.

Symptoms of OHSS can disappear within 7 to 10 days by proper management. For a pregnant woman, OHSS can get worse and last for many weeks. Hence, extra care is required during such special cases.

How to prevent OHSS?

Few preventive measures can be used to reduce the risk of OHSS during IVF treatment included are

  1. Decrease the dose of ovarian stimulating medications (Clomiphene citrate or gonadotropin-releasing hormone).

  2. Take Leuprolide drug instead of human chorionic gonadotropin (hCG) to prepare the eggs for release.

  3. Take Cabergoline drug which can facilitate to reduce the fluid accumulation.

  4. If women have a high risk of developing OHSS. In these cases, extra intravenous fluids are prescribed at the time of egg retrieval.

  5. Avoid tight clothes during IVF treatment.

Severe OHSS symptoms are found very rarely (only 1% women). However, OHSS during pregnancy increases the risk of development preeclampsia or premature baby birth.

If women experience any symptoms of OHSS, immediate attention should be given and she should contact IVF specialist. Experienced IVF specialist can easily manage mild to severe OHSS symptoms by proper management plan.

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