OHSS

Ovarian hyperstimulation syndrome (OHSS) may take place after a fertility medication is injected while doing an IVF (in vitro fertilization) procedure. The fertility or hormone medications are used to stimulate egg development in the ovaries. However, the amount of medication needed is not established, so it is difficult to tell the exact amount of medication required.

Ovarian hyperstimulation syndrome occurs when too much hormone is used, leading to swollen and painful ovaries. A small percentage of women who undergo IVF procedure may develop a severe case of OHSS, which involves abdominal pain, shortness of breath, vomiting and rapid weight gain. OHSS may also happen when oral fertility medications are taken.

In very rare cases, the syndrome occurs spontaneously, without any fertility treatment involved.

The symptoms of ovarian hyperstimulation syndrome (OHSS) may begin to manifest within 10 days after the fertility medication is injected. The symptoms can turn from mild to severe and may either improve or worsen over time. 

Symptoms of mild to moderate OHSS:

• Abdominal pain 
• Bloating
• Increased waistline
• Vomiting
• Diarrhea
• Nausea
• Feeling of tenderness around the ovaries

Symptoms of severe OHSS:

Rapid weight gain (as much as 10 pounds in three days)

• Severe pain in the abdomen
• Persistent vomiting and nausea
• Dark urine
• Decreased urination
• Shortness of breath
• Dizziness
• Enlarged abdomen

If you are receiving fertility medications and experience the symptoms of OHSS, see your doctor at once. 

The main cause of ovarian hyperstimulation syndrome (OHSS) is still unknown. An unusually high level of human chorionic gonadotropin (HCG) in your system is one of the culprits. HCG, a hormone produced in the course of pregnancy, causes the ovarian blood vessels to respond negatively and leak fluid. The leaked fluid will then result in the swelling of the ovaries but it may become exaggerated.

The doctor will diagnose ovarian hyperstimulation syndrome by doing the following steps:

• Physical examination. Your weight gain and waistline will be recorder, as well as the frequency and severity of your abdominal pain.
• Ultrasound. An ultrasound will show if your ovaries are enlarged and packed with fluid-filled cysts. The presence of these are indicative of OHSS.
• Blood tests. A number of blood tests will be done to check blood concentration and kidney function, among others. 

Generally, the symptoms of ovarian hyperstimulation syndrome (OHSS) disappear in a week or two without treatment. However, there are things you can do and medications you may take to ease the symptoms and keep you comfortable. Treatment may also be given to avoid further complications. 

Treatment for mild to moderate OHSS may include Anti-nausea medications and prescription painkillers. Your doctor may want to monitor your condition with frequent physical examinations, daily weigh-ins, regular waist measurement, regular ultrasound scans, and blood tests. Your doctor may also advise drinking more fluids to keep you hydrated and wearing support stockings to help support your weight and prevent blood clots. 

For severe cases, hospital confinement may be needed to ensure proper monitoring. You may also need intravenous fluids and certain medications to minimize your symptoms. Anticoagulant medications are sometimes prescribed to minimize the risk of blood clots. In some cases, serious complications may occur, which may require surgery. 

You can minimize your risk of having OHSS by getting only individualized fertility plan. You may do this by:

• Adjusting medication dosage. Ask your doctor if you can have the lowest possible hormone dosage in stimulating your ovaries.
• Coasting. This involves stalling the injections if a large number of follicles appear to have developed. The HCG injection may be given after a few days.
• Avoiding HCG trigger shots. Since OHSS usually occurs after a “trigger” shot, you may ask your doctor if an HCG replacement shot is available.
• Freezing embryos. Freezing embryos for later use will give your ovaries time to rest and your body to get ready for the pregnancy.

You can prevent ovarian hyperstimulation syndrome (OHSS) by getting only individualized fertility plan. You may do this by:

• Adjusting medication dosage. Ask your doctor if you can have the lowest possible hormone dosage in stimulating your ovaries.
• Coasting. This involves stalling the injections if a large number of follicles appear to have developed. The HCG injection may be given after a few days.
• Avoiding HCG trigger shots. Since OHSS usually occurs after a “trigger” shot, you may ask your doctor if an HCG replacement shot is available.
• Freezing embryos. Freezing embryos for later use will give your ovaries time to rest and your body to get ready for the pregnancy.

Lifestyle modifications are necessary in order to cope with ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome may not affect your everyday routine, unless the abdominal pain and other symptoms become so severe.

Your doctor may suggest taking acetaminophen or ibuprofen to ease down abdominal discomfort.

You may also have to avoid sexual intercourse because it can cause pain or your cysts to rupture.

If your symptoms get worse, see your doctor.