How to Prevent OHSS (Ovarian Hyper Stimulation Syndrome) during IVF

Ovarian Hyperstimulation Syndrome, known as OHSS for short, is a condition some women can develop as a result of taking certain fertility medications used in assisted reproductive technologies such as in vitro fertilization (IVF), a mini-IVF stimulation protocol (mini stim), or intracytoplasmic sperm injection (ICSI.) Because symptoms can range from mild to severe, and in some cases actually be life-threatening if not attended to immediately, you owe it to yourself to be informed about this syndrome. Let’s get a closer look at OHSS and what you can do to prevent it.

What is OHSS?

OHSS is an overreaction of the ovaries to excess hormones, usually as a result of injectable hormone medications. These medications are given to stimulate the development of eggs within the ovaries, and in some women cause an exaggerated response, resulting in painful ovarian swelling. Even though most cases of OHSS are caused by injectable medications, it can occur as the result of taking oral fertility treatment drugs such as clomiphene.

What Causes OHSS?

Although the exact cause of OHSS is not completely understood, research shows a role for high levels of HCG or human chorionic gonadotropin. HCG is normally produced during pregnancy by the placenta and is released into the bloodstream around eleven days after conception. This hormone then stimulates the corpus luteum, a structure in the ovary which in turn secretes progesterone, essential to maintaining the pregnancy.

High HCG levels can also be produced as a result of “trigger” injections used in fertility treatments, given to cause the egg to mature and then release from the ovary. In OHSS, the blood vessels in the ovary react abnormally and start to leak fluid, swelling the ovaries. If the amount of fluid becomes excessive, the fluid can move into the abdomen. Up to a third of all women undergoing IVF cycles experience mild symptoms of OHSS, with only 3 to 8 percent going on to develop moderate symptoms. Less than one percent of women will develop severe OHSS.

Risk factors for the development of OHSS include:

• history of a previous episode of OHSS
• age less than 35 years old
• low body weight
• history of polycystic ovary syndrome (PCOS.)
• estradiol levels that are high or increase sharply before HCG trigger shot. Estradiol, a form of estrogen produced by the ovarian follicles, can be especially high because of the multiple follicles that are produced as a result of the drugs.

When Do OHSS Symptoms Start?

Symptoms of OHSS usually start about one to two weeks after taking injectable medications, but this onset can vary with each individual. Some women will not begin experiencing symptoms until two weeks after the administration of the hormonal medications.

What Are OHSS Symptoms?

OHSS symptoms will differ depending on whether the OHSS is mild to moderate or it is severe.

Symptoms of mild to moderate OHSS can include:

• abdominal bloating,
• mild to moderate abdominal pain
• tenderness over your ovaries
• nausea
• vomiting

If the OHSS progresses to severe, symptoms can include:

• severe abdominal pain,
• rapid weight gain (more than 2 pounds within 24 hours)
• feeling of tightness in the abdominal area
• persistent nausea and/or vomiting
• shortness of breath
• noticeable decrease in urination
• blood clots

How Long Does OHSS last?

The mild form of OHSS usually lasts about a week. If pregnancy occurs as a result of the fertility treatment, the OHSS symptoms can actually worsen and can last several days to several weeks. Severe OHSS may require hospital treatment.

How to Treat OHSS?

Mild OHSS is usually treated conservatively with measures such as the avoidance of strenuous exercise, increased fluid intake to combat dehydration and acetaminophen for pain. You should rest often with your legs raised, as this will help your body to release the fluid. Avoid alcohol and beverages containing caffeine as they can make fluid retention worse. Your physician may also request that you weigh daily to stay ahead of any worsening of your status.

If you were to become dehydrated due to loss of fluids from vomiting or diarrhea, develop unmanageable abdominal pain, you experience rapid weight gain or worsening of other symptoms, your physician may elect to admit you to the hospital for treatment.

Can You Get OHSS After Embryo Transfer?

OHSS can also develop after an embryo transfer. Symptoms usually do not occur until the pregnancy has actually implanted and pregnancy hormones are starting to be produced about a week after the embryo has been transferred to your uterus.

Although developing OHSS does not decrease your chances of becoming pregnant, your fertility specialist may elect to delay embryo transfer if it occurs prior to transfer to give the OHSS symptoms time to resolve. If a fresh embryo transfer was going to be used, all embryos can be frozen until the condition subsides.

OHSS – When to Go to a Hospital?

If severe OHSS is left untreated, it can be extremely dangerous and in rare cases even fatal. Life-threatening complications can occur which can include fluid collection in the abdomen and even the chest causing breathing problems, disturbances in electrolytes (potassium, sodium and the like), development of blood clots in the large blood vessels of the legs, twisting (torsion) of an ovary, kidney failure and pregnancy loss due to miscarriage. If a cyst is present in the ovary, there is a possibility of rupture causing serious bleeding. Death can occur but this is rare.

If you experience worsening symptoms such as rapid weight gain, persistent nausea, vomiting or diarrhea, unmanageable abdominal pain, dizziness, difficulty breathing or inability to urinate, you should immediately go to your nearest emergency room and notify your physician.

How to Prevent OHSS after Egg Retrieval?

The most important factor in preventing OHSS after egg retrieval is careful physician monitoring of your injectable medications. If you have a pre-existing condition, such as PCOS that puts you at greater risk, your physician will likely monitor you even more closely.

Regular acupuncture treatments have been shown to be effective in reducing the occurrence of OHSS. Treatment once or twice a week prior to egg retrieval all the way through embryo transfer helps to prevent OHSS and can actually increase your chances of becoming pregnant!

Another helpful thing to do to prevent OHSS after egg retrieval is to stay hydrated, preferably with electrolyte rich solutions such as sports drinks or coconut water. You can also choose to make your own by adding a pinch of salt and orange and lemon slices into your glass.

OHSS – More Information

Now you have an understanding of exactly what OHSS is, including how it develops, the symptoms, and the dangers of leaving it untreated. You have tips on how to prevent OHSS, including careful monitoring, regular acupuncture and staying hydrated. You know how to treat mild OHSS at home with rest, hydration, acetaminophen, and keeping your physician informed. Most importantly, if OHSS worsens, you know what to look out for and when to go to the hospital. Of course, this information is not meant to take the place of your physician’s advice and you should always seek their direction should you experience any symptoms of OHSS, no matter how mild.

Considering Using Donor Eggs after Unsuccessful IVF

Whether you have experienced OHSS or had other reasons for a failed IVF procedure, at some point you may want to consider using a donor egg to become pregnant. This is a very personal decision, and for most women, it’s also an emotional one. None of us wants to be seen as “giving up” and trying to overcome the odds is a natural thing for humans to experience. The yearning for one’s own biological child is also deeply felt by most women.

Repeated IVF cycles are stressful and that stress must be weighed against the chances of having a healthy baby with the use of a donor egg. Some women are worried about the cost of using a donor egg, but multiple IVF cycles can also be quite expensive. Consulting with your fertility specialist and talking this decision over with your partner if available, will help you to make peace with this decision. Here at Santa Monica Fertility we are especially sensitive to the needs of women who have undergone unsuccessful IVF cycles and have decided to use a donor egg.

For more information on getting pregnant in your 40s and 50s, see this page. For information on using donor eggs, please go here.

Here at Santa Monica Fertility, we care deeply about all aspects of our clients’ fertility journeys, including being sure they have the latest information on topics such as OHSS, as well as many others. If you have questions or want more information we are always happy to assist you. Please  contact us online or call us directly at 310 – 566 – 1487. We look forward to hearing from you!