As a result of fertility treatments, the ovaries produce too many eggs, which leads to ovarian hyperstimulation syndrome (OHSS). The ovaries can swell and leak fluid into the abdomen and chest, causing abdominal pain, bloating, nausea, vomiting, and shortness of breath. OHSS can be mild, moderate, or severe, and usually resolves on its own within a few days or weeks. In some cases, OHSS can cause serious complications, such as blood clots, kidney failure, or ovarian torsion. It can be prevented by using lower doses of fertility drugs, monitoring the ovarian response, and avoiding pregnancy triggers.
Human chorionic gonadotropin (hCG), which is used to induce ovulation or pregnancy, stimulates the ovaries excessively, causing OHSS. Hormones such as these can trigger the ovaries to produce more eggs than usual, as well as increase blood flow and permeability in the ovary. Fluid can accumulate in the ovaries and abdominal cavity, as well as an imbalance in blood electrolytes and proteins.
OHSS can be caused by a number of factors, including:
Having polycystic ovary syndrome (PCOS), a hormonal disorder characterized by irregular periods and multiple cysts in the ovaries
Young, underweight, or having a low body mass index (BMI)
A high number of follicles or eggs in the ovaries
Blood levels of estrogen are high
Fertility drugs taken in high doses or in multiple forms
Having a history of occupational health and safety problems
Pregnancy during or after fertility treatment
OHSS symptoms vary according to severity. They usually develop within 10 days after ovulation or embryo transfer. Mild to moderate OHSS symptoms include:
Pain, cramps, or discomfort in the abdomen
Bloating or swelling in the abdomen
Diarrhea, nausea, or vomiting
A daily weight gain of more than 2 pounds (1 kilogram)
Dark-colored urine or decreased urination
Severe OHSS symptoms include:
Distension or pain in the abdomen
Chest pain or difficulty breathing
Palpitations or rapid heartbeat
Feeling dizzy or faint
Urine or stool containing blood
Changes in mental state or confusion
On the basis of the medical history, the physical examination, and laboratory and imaging tests, OHSS is diagnosed. An examination will include questions about the symptoms, the onset and duration of the symptoms, fertility treatment, and pregnancy status, as well as a physical examination that includes:
Vital signs, such as blood pressure, pulse, and temperature, should be checked
Checking the abdomen for swelling, tenderness, or fluid accumulation
Congestion or fluid overload can be detected by listening to the lungs and heart
Checking the ovaries for enlargement, pain, or cysts
Some laboratory and imaging tests may also be ordered by the doctor, including:
In blood tests, hormones, electrolytes, proteins, blood cells, and liver and kidney functions can be measured
A urine test can measure the concentration and specific gravity of urine
The ultrasound can reveal the size and number of follicles in the ovaries, as well as the amount and location of fluid in the abdomen.
A CT scan or MRI can provide more detailed images of the ovaries and abdominal organs, as well as detect any complications, such as blood clots or ovarian torsion
A patient's treatment for OHSS depends on the severity and complications of the condition, as well as their pregnancy status. Its main objective is to relieve the symptoms, prevent complications, and support the pregnancy, if any. The treatment options include:
Treatment that involves noninvasive methods, such as:
Exercise, sex, and travel can worsen symptoms, so rest and activity modification are recommended
Fluid and electrolyte management involves drinking enough fluids to prevent dehydration, but not too much to avoid fluid overload, and avoiding alcohol, caffeine, and salty foods that can cause fluid retention.
Relieving abdominal pain or discomfort with over-the-counter or prescription painkillers such as acetaminophen, ibuprofen, or naproxen
Medications that prevent or treat nausea and vomiting, such as metoclopramide, ondansetron, or promethazine
Thromboprophylaxis involves taking drugs that prevent or treat blood clots, such as aspirin, heparin, or warfarin, especially if you have a history of thrombosis
Surgical or medical procedures that involve invasive treatment, such as:
Using a needle or a catheter, paracentesis drains the excess fluid from the abdomen, relieving the pressure and the pain
In thoracentesis, excess fluid is drained from the chest with a needle or catheter, and breathing and oxygenation are improved
Using a needle or catheter, ovarian aspiration removes some of the follicles or cysts from the ovaries, reducing their size and hormone production
An ovarian surgery is a procedure in which part or all of the ovaries are removed, using a laparoscope or an open incision, in order to prevent recurrence or complications of OHSS.
An antagonist of gonadotropin-releasing hormone (GnRH), which prevents ovarian stimulation and fluid leakage by blocking the action of hCG
There are some measures that can be taken to reduce the risk or severity of OHSS, such as:
In order to avoid overstimulation of the ovaries, use lower doses or shorter courses of fertility drugs
A lower risk of OHSS is associated with alternative methods of ovulation induction, such as clomiphene citrate, letrozole, or metformin.
Alternative methods of triggering ovulation, such as GnRH agonists, have a lower risk of OHSS than hCG
If the risk of OHSS is high or the symptoms are severe, the embryo transfer should be delayed or canceled, and the embryos should be frozen for later use
When the risk of OHSS is high or symptoms are severe, avoid pregnancy triggers such as intercourse, IUI, or progesterone supplementation
