Ovarian Hyperstimulation Syndrome (OHSS): Understanding, Risks, and Treatment

Ovarian Hyperstimulation Syndrome (OHSS) is a serious condition that can occur in women undergoing fertility treatments, particularly in response to ovarian stimulation during in vitro fertilization (IVF). It is caused by an overreaction of the ovaries to fertility drugs that stimulate the production of eggs. While OHSS is rare, it can range from mild to severe, with the severe form requiring medical attention. Understanding OHSS, its symptoms, risk factors, prevention, and treatment options is crucial for women undergoing fertility treatments.

Understanding Ovarian Hyperstimulation Syndrome (OHSS)

Ovarian Hyperstimulation Syndrome (OHSS) is a complication of fertility treatment, especially IVF, where the ovaries become overly stimulated due to the use of hormone injections designed to encourage egg production. When the ovaries are overstimulated, they can swell and leak fluid into the abdomen and chest. The condition can cause significant discomfort and, in severe cases, can lead to life-threatening complications.

OHSS typically occurs after the administration of human chorionic gonadotropin (hCG), a hormone used to trigger ovulation once eggs are ready to be retrieved during an IVF cycle. The condition usually manifests within a few days after hCG injection, though mild cases may not be noticed until after embryo transfer.

What Are the Symptoms?

Symptoms of OHSS can vary from mild to severe. In mild cases, symptoms may resolve on their own, while in severe cases, medical intervention is required.

Mild Symptoms

• Abdominal bloating
• Mild to moderate abdominal pain
• Nausea
• Vomiting
• Diarrhea
• Weight gain (a few pounds)

Moderate to Severe Symptoms

• Severe abdominal pain and discomfort
• Significant weight gain (more than 5 pounds within a few days)
• Swelling in the abdomen, legs, and sometimes the chest
• Shortness of breath
• Dizziness or fainting
• Decreased urine output or dark urine
• Rapid weight gain over several days (more than 10 pounds)
• Abdominal distention or bloating to the point of discomfort

Severe OHSS requires immediate medical attention, as the condition can lead to more serious complications, including kidney failure, blood clots, or fluid accumulation in the lungs (pulmonary edema).

Who is at Risk?

While OHSS can occur in any woman undergoing fertility treatments, certain factors increase the risk. Women at higher risk of developing OHSS include:

1. Young Women: Women under the age of 35 are more likely to develop OHSS, especially those who are using fertility treatments such as IVF.
2. Women with Polycystic Ovary Syndrome (PCOS): Women with PCOS often produce a higher number of eggs during ovarian stimulation, which increases the risk of OHSS.
3. High Ovarian Reserve: Women with a high ovarian reserve (the number of eggs available in the ovaries) may produce many eggs, increasing the likelihood of overstimulation.
4. Previous OHSS: Women who have had OHSS in a previous IVF cycle are at a higher risk of developing the condition again.
5. High Dose of Fertility Medications: Women who receive high doses of fertility medications to stimulate egg production are more prone to developing OHSS.
6. Pregnancy After IVF: Women who become pregnant after an IVF cycle may be at higher risk for developing OHSS because the pregnancy hormone hCG can exacerbate the effects of ovarian stimulation.

What Should Be Done?

If you suspect you have OHSS or if you experience any symptoms, it is crucial to seek immediate medical attention. Early detection is key to managing the condition and preventing complications.

What to Do:

1. Contact Your Doctor: If you experience symptoms such as bloating, pain, nausea, or rapid weight gain, inform your fertility clinic or healthcare provider right away.
2. Monitor Symptoms: Keep track of your symptoms, including weight gain, abdominal discomfort, and fluid retention. If symptoms worsen, seek medical care urgently.
3. Follow Medical Advice: Your doctor may recommend reducing the use of certain medications or might take a blood test to monitor hormone levels. They may also ask you to drink plenty of fluids and reduce salt intake to help manage the condition.

Can OHSS Be Prevented?

While it may not always be possible to prevent OHSS entirely, there are several strategies to reduce the risk:

1. Careful Monitoring: Fertility specialists can closely monitor ovarian response through ultrasounds and blood tests during the ovarian stimulation phase to adjust medication doses as needed.
2. Adjusting Medication Doses: A lower dose of fertility drugs can help prevent excessive stimulation of the ovaries. This is especially important for women with high ovarian reserves or those at high risk of OHSS.
3. Using GnRH Agonists Instead of hCG: In some cases, a GnRH agonist (gonadotropin-releasing hormone agonist) may be used instead of hCG to trigger ovulation, which has been shown to reduce the risk of OHSS.
4. Freezing Embryos (Egg Freezing): If a woman is at high risk of OHSS, the IVF cycle can be paused, and eggs can be frozen for future use. This method prevents immediate pregnancy and reduces the risk of OHSS.

 

How is OHSS Treated?

Treatment for OHSS depends on the severity of the condition. Mild cases usually resolve with self-care and monitoring, while severe cases may require hospitalization.

Treatment Options Include:

1. Mild Cases:
   • Increased fluid intake to avoid dehydration
   • Rest and avoiding physical exertion
   • Pain relief medications (if prescribed)
   • Monitoring for any signs of worsening symptoms
2. Moderate to Severe Cases:
   • Hospitalization: In severe cases, hospitalization may be required for observation and fluid management.
   • Intravenous (IV) Fluids: To restore lost fluids and prevent dehydration due to fluid shifts in the body.
   • Electrolyte Monitoring: Blood tests may be done to check for imbalances in electrolytes.
   • Drainage of Abdominal Fluid: If the abdomen is severely distended, excess fluid may be drained to relieve pressure.
   • Supportive Care: In some cases, additional treatments may include blood thinners to prevent clotting and pain relief.
3. Severe OHSS with Pregnancy: If a woman with OHSS becomes pregnant, the condition may improve as the pregnancy progresses, but medical supervision is essential to monitor the health of both the mother and the developing fetus.

 

Conclusion

Ovarian Hyperstimulation Syndrome (OHSS) is a potential complication of fertility treatments, particularly for women undergoing IVF. Although rare, it can lead to significant discomfort and, in severe cases, life-threatening complications. At MotherToBe Fertility Centre, we prioritize your health and safety throughout the IVF process. We closely monitor your ovaries during treatment to detect any early signs of OHSS and take preventive measures to minimize the risk.

 

Recognizing the symptoms of OHSS early—such as abdominal bloating, pain, nausea, or difficulty breathing—is crucial. If you suspect OHSS, it’s essential to seek immediate medical attention to ensure proper management. Our fertility specialists will work with you to determine the best course of action based on your individual circumstances, helping you maintain your health and well-being during your IVF journey.

Frequently Asked Questions (FAQs)

 

1. What is OHSS and why does it occur?

Ovarian Hyperstimulation Syndrome (OHSS) is a condition that occurs when the ovaries react too strongly to fertility drugs used in IVF. This overstimulation leads to swelling and fluid leakage in the abdomen and chest, causing discomfort and potential complications.

2. How can I tell if I have OHSS?

Symptoms of OHSS can include abdominal bloating, nausea, vomiting, weight gain, abdominal pain, and shortness of breath. Severe symptoms like rapid weight gain and severe pain require immediate medical attention.

3. Who is at risk for OHSS?

Women under 35, those with PCOS, high ovarian reserve, or a history of OHSS are at a higher risk. Women receiving high doses of fertility medications are also more likely to develop OHSS.

4. Can OHSS be prevented?

While OHSS cannot always be prevented, careful monitoring of hormone levels, adjusting medication doses, and strategies like freezing eggs or embryos can help reduce the risk.

5. How is OHSS treated?

Treatment depends on severity. Mild cases may resolve with hydration and rest, while severe cases may require hospitalization, IV fluids, and monitoring of electrolytes and fluid levels. Severe cases with pregnancy may improve over time with proper medical supervision.