How to Prevent Ovarian Hyperstimulation Syndrome After Egg Retrieval?Fertility Treatment
Ovarian Hyperstimulation Syndrome (OHSS) is a possible complication of fertility treatments that occurs in some women.
In simple terms, OHSS is mainly an excessive response of the ovary to excess hormones caused by some fertility treatment methods such as IVF (in vitro fertilization), IUI treatment (intrauterine insemination), or ovulation induction injections. Severe symptoms of ovarian hyperstimulation syndrome (OHSS) include abdominal pain, dyspnea (shortness of breath), and vomiting.
OHSS, also known as Hyperovulation, is a concern for women who undergo IVF for fertility treatment. Therefore, it is essential to diagnose OHSS in its early stages and learn how to treat it.
What Is Ovarian Hyperstimulation Syndrome (OHSS)?
Ovaries are two small 3-cm-long almond-shaped organs. One of the ovaries naturally releases a mature egg monthly during ovulation. Fertilization occurs when the mature egg enters the uterine tube (fallopian tube) and moves toward the sperm.
Finally, in the implantation stage, the fertilized egg enters the uterus and makes contact with the uterine wall. If pregnancy does not occur, the uterine wall that is thickened for implantation of the fertilized egg sheds and the period begins.
However, when the ovulation process cannot occur naturally, a fertility treatment such as IVF or IUI is recommended to the patient. OHSS is one of the side effects of these assisted reproductive technologies.
Who Is at Risk of OHSS?
OHSS sometimes occurs in women who take or inject hormonal medications such as HCG (human chorionic gonadotropin). These ovulation stimulation medications may increase ovarian activity and cause the ovaries to swell and become painful.
Furthermore, women who undergo ovarian stimulation or fertility treatment with the help of medications such as Clomiphene Citrate are at risk of OHSS. Also, in women with natural twins or multiple pregnancies, the high level of HCG hormone can cause ovarian hyperstimulation syndrome.
What Are the Symptoms of Ovarian Hyperstimulation Syndrome?
OHSS usually ranges from mild to moderate, and its severe cases are rare. The mild to moderate symptoms of the condition is temporary and will improve within a week; however, OHSS symptoms get worse in the case the pregnancy occurs and may last for several weeks.
Symptoms of mild to moderate OHSS include:
- Rapid weight gain to more than 3 kg;
- Increased waist size;
- Abdominal pain;
- Nausea and vomiting;
- Uterine prolapse.
Symptoms of severe OHSS include:
- Extreme rapid weight gain to about 15-20 kg in 10 days;
- Tight or enlarged abdomen;
- Ascites (abdominal fluid);
- Severe abdominal pain;
- Pelvic pain;
- Severe and persistent nausea and vomiting;
- Shortness of breath, cough, and chest pain;
- High blood concentration;
- Decreased urination;
- blood clots in legs,
- Swelling above the ankle,
- Dry skin and hair.
What Causes the Ovarian Hyperstimulation Syndrome?
Using Controlled Ovulation Hyperstimulation (COH) by HCG hormone can cause OHSS after egg retrieval. Women's bodies produce adequate amounts of the HCG hormone during pregnancy. Extra HCG to induce ovulation cause the ovarian blood vessels to react and leak fluid. The fluid leakage causes the ovaries to enlarge and swell. These fluids may also enter the abdomen and cause abdominal swelling after the egg retrieval.
What Are the Risk Factors for Ovarian Hyperstimulation Syndrome?
Some physical factors increase the risk of OHSS. However, OHSS may sometimes occur with no risk factors.
Risk factors of ovarian hyperstimulation syndrome include:
- Low body weight;
- Age under 30;
- A large number of follicles;
- Polycystic ovary syndrome;
- An increased level of estradiol before ovulation stimulation with HCG injection;
- Prior history of migraine;
- Prior history of OHSS;
- Prior history of multiple pregnancies.
What Are the Complications of Ovarian Hyperstimulation Syndrome?
About 1-2% of women using ovulation stimulation procedures suffer from severe OHSS. This condition will be associated with numerous complications, including:
- Electrolyte (sodium, potassium, etc.) imbalances;
- Breathing problems;
- Blood clots in the large vessels, usually in the legs;
- Fluid accumulation in the abdomen (Ascites) and sometimes in the chest;
- Kidney failure;
- Ovarian torsion;
- Ruptured ovarian cyst;
- Unwanted abortion.
How Is Hyperstimulation Syndrome (OHSS) Diagnosed?
There are some tests to diagnose ovarian hyperstimulation syndrome. These include:
- Blood test: to measure kidney disorders and examine abnormality in the blood;
- Chest X-ray imaging: to check the possible fluid accumulation;
- Ultrasound: to measure the condition and size of the ovaries (if they are filled with fluid);
- Physical examination: to evaluate any abdominal pain, weight gain, or increased waist size.
Ovarian Hyperstimulation Syndrome (OHSS) Treatment
OHSS treatment depends on the disease severity. In mild cases, the condition will improve within 1 to 2 weeks. However, severe cases may need additional treatment at the physician's discretion, and the recovery will take much longer.
Mild to Moderate OHSS Treatment
Mild to Moderate cases of the OHSS condition will improve by drinking more fluid, daily sizing the waist circumference, and measuring urine 24-hour volume. Frequent physical examinations, ultrasounds, electrolyte tests, and draining fluid from the abdomen (paracentesis) will also significantly improve mild OHSS.
Severe OHSS Treatment
In severe cases of OHSS, the doctor uses injectable medications to control and treat the condition, e.g., injectable cabergoline. This medication lowers prolactin hormone levels in the body and relieves the symptoms of severe ovarian effusion.
Anticoagulants also play an effective role in reducing or preventing blood clots in the body. Gonadotropin-releasing hormone (Gn-RH) antagonists such as letrozole can be used to control high ovarian activity. It reduces the symptoms of OHSS in patients and speeds up recovery.
Furthermore, appropriate treatment methods for ruptured ovarian cysts and specialized care to prevent liver, kidney, or lung complications are among the effective methods in treating severe OHSS.
Home Remedies for Managing Ovarian Hyperstimulation Syndrome (OHSS)
According to sources, it is safe to use over-the-counter pain relievers such as acetaminophen to relieve abdominal pain in OHSS. It is better to avoid other pain-relieving medications like naproxen and ibuprofen to prevent implantation failure.
Additionally, several home remedies help improve OHSS apart from the treatment methods prescribed by the doctor. One of these home remedies is to have a healthy diet, including 2-3 egg whites daily or salty foods. Consuming plenty of liquids, fruits and vegetables also helps relieve constipation.
Another home remedy for ovarian hyperstimulation syndrome is to make lifestyle changes. Maintaining a normal weight, daily measuring abdomen circumference, avoiding heavy physical activities, and not having sexual intercourse helps prevent an ovarian cyst from rupturing.
How to Prevent OHSS?
To reduce the odds of OHSS development, patients should take their medications regularly, do frequent ultrasounds to check follicles, and perform blood tests to measure the level of hormones.
Strategies to prevent the incidence of OHSS are as follows:
- Coasting (withdrawing exogenous gonadotrophins): If the estrogen level is high and there are many developed follicles in the body, the doctor will temporarily stop injectable medications and HCG hormone from lowering the hormone levels and reducing ovarian sensitivity. When the levels decline as desired, the injection program continues.
- Avoiding the use of HCG hormone: Since HCG may increase the chance of OHSS development in the body, alternatives to HCG can be used to prevent OHSS. These alternatives include Gn-RH agonists, such as leuprolide (Leuprorelin).
- Using certain medications: To induce ovulation, the doctor usually prescribes the lowest dose of gonadotropins. Some specific medications can reduce the risk of OHSS without having a negative effect on pregnancy. These include metformin (for women with polycystic ovary syndrome), aspirin, cabergoline, and intravenous calcium infusion.
- Embryo freezing: In the case of observing OHSS symptoms while undergoing IVF, the doctor should remove all mature and immature eggs. Therefore, the ovaries can rest for a while. During this period, the matured eggs are frozen, and then, when the body is ready, the IVF process will be continued.
When Is the Best Time to See a Doctor?
Patients should inform their doctor if they observe any OHSS symptoms (even very mild symptoms) during a treatment cycle. It is better to write down the symptoms and list any medications and vitamin supplements they take.
Furthermore, it is necessary to listen to the doctor carefully, ask important questions, and write down important information to avoid more complications and prevent the development of OHSS.