Ovarian Hyperstimulation Syndrome (OHSS)
OHSS occurs in approximately 1-5% of treatments with injection medications. Risk factors that predispose a woman to OHSS include polycystic ovarian syndrome (PCO) and other ovulatory disorders. OHSS will usually present as mild symptoms fairly early after administration of HCG. The symptoms can worsen when a pregnancy occurs. An increased number of follicles on your ovaries and/or the presence of high levels of estrogen in your blood increase your risk for developing OHSS. In most cases of mild OHSS, symptoms are usually mild and require no treatment other than drinking extra fluids. In severe cases, OHSS may result in blood clots, kidney damage, ovarian torsion (twisting), or abdominal and chest fluid collections. In these severe cases (1%), hospitalization may be required for IV fluids, monitoring, and removal of the fluid collections. In pregnancy, OHSS may persist for 10-30 days.
OHSS is more of a spectrum of changes. Patients can have any degree of symptoms and not just mild or severe. The degree of OHSS can change with time and fluid status as well. You should monitor your weight daily and keep in close contact with the clinic.
Mild to Moderate Abdominal Pain
5-10 lb weight gain in 3-5 days
Severe Abdominal Pain
Decreased Urinary Frequency
Shortness of Breath
>10 lb Weight Gain in 3-5 days
Please call us immediately if any of these symptoms of severe OHSS occur. If you require treatment by anyone other than our physicians (e.g. an out of town emergency room), please do not allow a pelvic exam or aggressive abdominal exam. If the physician has any questions, have them call us.
After the follicles in the ovary have ruptured or have been aspirated, they can fill back up with fluid. This causes the ovaries themselves to become enlarged. The symptoms of OHSS are thought to come from the fluids and substances released from the over stimulated ovaries. Large amounts of fluid are transferred into the abdomen causing dehydration and abdominal bloating as well as other symptoms. HCG worsens the symptoms of OHSS and therefore patients who become pregnant may experience a prolongation of symptoms. Frustration from prolonged pain and inability to get comfortable are the most bothersome aspects of OHSS for most individuals. There is not any treatment to make this go away. Drinking a lot of fluids is the best preventative medicine to keep a bad situation from getting worse. To help alleviate symptoms and prevent severe OHSS, please follow these instructions:
- Drink plenty of fluids - at least 10-12 glasses per day or 1 8 oz glass per hour while awake.
- Drink enough so your urine is clear or pale yellow. You should be emptying your bladder every 2 hours.
- Avoid alcohol and caffeinated beverages (colas, tea, Mountain Dew, coffee).
- You may use extra strength Tylenol if needed for pain.
- Weigh yourself at the same time on the same scale each day to monitor for rapid weight gain.
There are times when we recommend canceling treatment cycles or delay retrievals due to the risk of hyperstimulation. "Coasting" can be done for patients on Lupron, Antagon, or Cetrotide. This involves continued use of Lupron, or an antagonist, without gonadotropins. This allows of the resolution of smaller follicles and a decline in estradiol. Cancellations and coasting are done with the patients well being as the primary concern. Estradiol levels may be used to monitor the risk of ovarian hyperstimulation. A history of irregular menses is one of the strongest factors associated with ovarian hyperstimulation so it is important to notify your physician of any history of irregular menses.