Ovarian Hyperstimulation Syndrome (OHSS) is a painful and potentially dangerous condition in which the ovaries become severely inflamed. OHSS occurs as an exaggerated response to an influx of hormones, typically the hormone injections given as part of the IVF cycle. Though rare, OHSS may happen as a result of inducing the ovaries to mature several eggs at one time as preparation for egg retrieval.
One major complication of OHSS occurs when the ovaries begin leaking fluid. As the ovaries swell, the blood vessels become porous, helping release fluid. This fluid leaks into your pelvic region, abdomen, and may even enter your chest cavity on very rare occasions. This can lead to very dangerous complications.
What Causes OHSS?
While the exact causes of OHSS aren’t fully known, doctors recognize the relationship between HCG (human chorionic gonadotropin), a pregnancy hormone, and this condition. OHSS sometimes occurs naturally when there’s a high level of HCG. This happens when a woman carries multiple fetuses, has a molar pregnancy (an abnormal cluster of cells instead of an embryo and placenta), or has a specific thyroid condition.
When undergoing IVF, OHSS is a risk as well. As part of the IVF protocol, your doctor prescribes injectable hormones that encourage many eggs to develop at one time, as well as a “trigger shot” of HCG. Within a week of the trigger shot, you may notice the symptoms of OHSS. When pregnancy occurs, your body produces its own HCG, and your symptoms may become even worse.
It’s important to note that injectable hormones are the more likely culprit when OHSS occurs. Oral medications rarely contribute to the condition. But, as stated above, OHSS also might occur naturally.
Who is More Prone to OHSS?
Not everyone who undergoes IVF, or any other fertility treatment, is at risk for OHSS. Sometimes it happens in those with no risk factors at all, but some conditions may predispose a woman to OHSS. These risk factors include:
- Prior episodes of OHSS
- Being underweight or of low body weight
- Higher than normal levels of estrogen, or estrogen spikes, right before a trigger shot of HCG.
- Women under the age of 35.
- PCOS
- A large number of follicles within the ovaries.
If you have any of these risk factors, your doctor is most certainly aware, as they monitor you very closely while you undergo treatment such as IVF.
Symptoms of OHSS
As mentioned, OHSS symptoms typically begin within a week of your trigger shot of HCG, although symptoms may show a few days later in some cases. Mild to moderate symptoms may become worse over time or improve as days go by. Here are some things to watch for.
Mild to Moderate OHSS may present with these symptoms:
- Pain or tenderness in the pelvic region.
- Bloating, puffiness, or a noticeable change in how your clothes fit around your waist.
- Abdominal discomfort or pain ranging from mild to moderate.
- Gastric changes, such as diarrhea.
- Nausea.
- Loss of appetite.
- Vomiting.
If these symptoms persist or get worse, you may have severe OHSS. And your symptoms may become increasingly severe with pregnancy. Be aware of these symptoms of severe OHSS:
- Shortness of breath, chest pain, or difficulty breathing.
- Severe and persistent nausea and vomiting. Inability to keep food down.
- Severe abdominal pain that lasts more than 24 hours.
- Decreased urination.
- Rapid weight gain of more than 2-3 lbs in 24 hours.
- Enlarged abdominal area, tightness in the abdomen.
- Pain, swelling, redness, or “hot spots” in your legs.
Notify your doctor if you experience any of these symptoms. Even mild symptoms of OHSS may become severe in short order. However, severe symptoms can indicate an emergency, so notify your doctor’s office immediately. Don’t ignore your symptoms, as complications may develop, including:
- Ovarian torsion, a dangerous condition in which the ovary twists on the supporting ligaments and cuts off blood supply to the ovary. Damage to the ovary may impact your fertility.
- Fluid may collect in your abdominal area or chest, constricting your organs.
- Development of large-vessel blood clots, particularly in the legs.
- Imbalances of electrolytes such as potassium and sodium. Untreated, this can harm your kidneys and even cause kidney failure.
- Miscarriage due to complications of OHSS.
- Rarely, but left untreated, OHSS can be fatal.
What You Can Do About OHSS
Talk to your doctor about your risk for OHSS. You may need a personalized approach to your fertility treatment. That approach may involve adjusting your medications, adding certain medications, and freezing your eggs and/or your embryos.
At LA IVF, we feel a personalized approach is the only way to treat infertility. Everyone is unique, and every diagnosis deserves treatment tailored to your needs. For more information on OHSS and your fertility, please contact LA IVF today.
