A possible complication of in vitro fertilization (IVF), in which the ovaries swell and fluid leaks in the abdominal area, is called ovarian hyperstimulation syndrome (OHSS). Commonly, females with PCOS who are going through fertility treatments develop OHSS.
Normally, women release one egg each menstrual cycle. If they have problems with fertility, doctors may recommend hormonal medicines to produce multiple eggs (especially if you plan an egg retrieval procedure and in vitro fertilization). Sometimes, these medicines may cause your ovaries to overrespond or overreact, causing OHSS.
Previously, OHSS was a common complication of IVF, but new protocols and strategies helped reduce the frequency of this complication. In general, this complication occurs in about 10% of women who are undergoing controlled ovarian stimulation for IVF. Moreover, a severe form of OHSS happens in less than 1% of women who receive ovarian stimulation.
Types of OHSS
This complication can be mild, moderate, or severe. Doctors classify it based on the symptoms you experience. While most cases are mild and cause temporary discomfort, more severe cases can be life-threatening.
Symptoms
The symptoms often appear differently among people because they depend on the severity of the complication. Usually, the symptoms begin to appear within a week after using hormonal medicines that stimulate the ovaries. Check some common symptoms below:
- Abdominal pain
- Bloating
- Nausea
- Weight gain
In more severe cases, people may experience the following symptoms. Examples include:
- Blood clots
- Excessive body weight
- Severe nausea, vomiting, and abdominal swelling
- Breathing problems
- Reduced urination
It is very important to see a doctor if any of the previous symptoms occur. While mild cases may go away on their own, in more severe cases, people often need treatment to relieve the symptoms and treat this complication.
Causes and Risk Factors
Most people develop this complication of IVF due to the hormone HCG (human chorionic gonadotropin) that stimulates their ovaries. Usually, the ovaries produce only one egg during each menstrual period. However, if you have problems with fertility, doctors may prescribe hormonal medicines to help the eggs mature before the egg retrieval process of IVF. Sometimes, the ovaries may overreact to these medicines and produce excessive eggs and develop OHSS. As a result, the blood vessels that surround the ovaries may begin to leak. If this fluid travels to the abdominal area, you may experience swelling and pain.
Furthermore, healthcare professionals have identified some factors that may increase your risk for OHSS. For example:
- PCOS (polycystic ovary syndrome)
- Previous OHSS
- Multiple follicles or an increased level of Estrogen during IVF stimulation
- High doses of HCG
- Undergoing an embryo transfer (it occurs when a female gets pregnant while her ovaries are still stimulated)
The risk of developing OHSS increases if you are under 30 years old or weigh less than average.
What Happens if Ovarian Hyperstimulation Syndrome is Left Untreated?
People who develop OHSS may also experience other complications, especially without treatment. Check some of them below:
- Thrombosis (blood clots) in the lungs or legs
- Stroke
- A painful swelling in the leg
- Chest pain (also known as angina)
- Ovarian cysts
- Bleeding
- Kidney problems
- Electrolyte imbalance
- Ovarian torsion
Immediately call 911 or go to the nearest emergency room (ER) if any of the following symptoms occur. Examples include:
- Dyspnea (shortness of breath)
- Lack of urination for more than 8 hours
- Sudden and severe abdominal pain
- Fainting
- Persistent vomiting
How to Prevent Ovarian Hyperstimulation Syndrome?
Unfortunately, it is not always possible to prevent OHSS. However, doctors may recommend some tips to reduce the risk. For example:
- Reduce or change the dosage of the fertility medicine
- Avoid HCG during treatment
- Change the type of fertility medicine (especially if you begin to experience some symptoms)
- Freeze the embryos and delay their transfer until the ovaries return to normal
Diagnosis
Usually, doctors diagnose OHSS by performing the following tests. For example:
- Physical examination – During this procedure, doctors will check for abnormalities linked to the disease, including the size of the waist, swelling, and others.
- Ultrasound – This is an imaging test that uses sound waves to produce images. It often helps detect free fluid in the abdomen and the size of the ovaries.
- Chest X-ray – It helps identify fluid in the chest.
- Blood tests – This test is used to measure hormone levels in the blood.
Treatment
The treatment for OHSS varies among people because it depends on several factors. For example, the severity of the complication, age, overall health, and preferences. While mild forms do not need treatment because they go away on their own, in more severe cases, doctors may recommend some options. Check some treatment options below:
Mild OHSS
- Avoid strenuous physical activity
- Drink electrolyte-rich fluids
- Use over-the-counter (OTC) pain relievers, such as Acetaminophen
- Weigh yourself each day
- Inform your doctor if you begin to experience severe symptoms
Severe OHSS
- Intravenous (IV) fluids to prevent dehydration
- Paracentesis (during this procedure, doctors will remove fluid from the abdominal area)
- Medicines to reduce the activity of the ovaries
- Blood thinners (also called anticoagulants) to reduce the risk or treat a blood clot
Although rare, some people may need to stay in the hospital until the symptoms improve.
Frequently Asked Questions
How long does it take to recover from OHSS?
In general, the recovery time varies among people who develop OHSS. While some people may recover within 1 week, others may need 1 month to recover completely. For more details, discuss it with your doctor.
How do you get rid of OHSS fast?
Unfortunately, it is not possible to get rid of this complication quickly. In any case, you should see a doctor for a diagnosis and treatment if any of the previous symptoms occur.
Can you still have a healthy pregnancy with OHSS?
Yes, because this complication does not affect the pregnancy. With treatment, the symptoms will disappear without affecting your pregnancy. If you have any other questions, ask your healthcare provider.
