What Is Ovarian Hyperstimulation Syndrome (OHSS)?

OHSS full form, i.e., ovarian hyperstimulation syndrome, is an exaggerated ovarian response to hormone injections taken in a process aimed at improving fertility. In such instances, the ovaries may enlarge with increased fluid accumulation, which may lead to intense pain alongside medical complications. This tends to occur in multiple egg formations within the ovaries stimulated by hormone-injectable medication.

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Symptoms of OHSS: Mild, Moderate, and Severe

Observing symptoms might help identify OHSS early on. The symptoms of ovarian hyperstimulation syndrome can vary widely depending on the severity of the condition.

  • Mild to Moderate OHSS
    1. Abdominal pain and bloating
    2. Nausea, vomiting, and diarrhoea
    3. Tenderness in the ovaries
    4. Mild weight gain or waistline increase

In mild cases, the symptoms do tend to subside after a week. However, if early pregnancy occurs, symptoms can also become prolonged due to heightened hormone levels.

  • Severe OHSS
    1. Shortness of breath and tight abdomen
    2. Persistent severe abdominal pain

Severe OHSS requires immediate medical intervention. Left untreated, it can lead to major complications such as blood clots or kidney issues.

What Causes OHSS?

OHSS is more common in women undergoing in vitro fertilisation or using injectable fertility drugs.

  • Polycystic Ovary Syndrome (PCOS): Women suffering from PCOS are at higher risk due to hormonal imbalance.
  • Previous OHSS: A history of OHSS in previous IVF cycles increases the likelihood of reoccurrence.
  • High Follicle Count or Oestrogen Levels: IVF stimulation with a high egg supply and higher oestrogen levels can expose you to higher risks (when estrogen levels exceed 3,000-5,000 pg/mL).
  • High-Dose HCG: A history of IVF cycles with higher doses of HCG for stimulation will increase the risk.

How Is OHSS Diagnosed?

OHSS may be diagnosed by incorporating signs and symptoms with blood tests and ultrasounds:

  • Physical Examination: A specialist may examine symptoms such as swelling in the abdomen, pain, or fast weight gain.
  • Blood Tests: Blood tests are advised to gauge the severity of the condition.
  • Ultrasound: There might be distended ovaries, which is one of the mainstays in the presentation of OHSS patients undergoing IVF treatment.

What Are the OHSS Treatment Options?

OHSS treatment and its management would depend on the severity. Mild symptoms of OHSS will heal on their own while on minimal medical intervention. Moderate cases of OHSS require close observation at home, and severe cases may need hospitalisation.

  • Mild to Moderate OHSS
    1. Avoiding vigorous physical activity to prevent further complications.
    2. Staying hydrated, especially with electrolyte-rich fluids
    3. Using pain relief medication, under supervision, to manage discomfort
    4. Daily self-monitoring of symptoms, including weight and abdominal size
  • Severe OHSS
    1. Hospitalisation: Severe cases may require hospitalisation for close monitoring and supportive care.
    2. Intravenous Fluids: Rehydration and electrolyte balance may be managed through IV fluids.
    3. Paracentesis: In some cases, fluid build-up around the abdomen may need to be drained.
    4. Blood Thinners: Anticoagulant medications may be administered to lower the risk of clot formation.

Minimising OHSS Risk in IVF

Though not entirely preventable, the risk of OHSS can be managed through careful monitoring and protocol adjustments:

  • Personalised Medication Dosage: Fertility doctors can individualise protocols regarding a medication set to reduce the chance of developing OHSS in women who are at risk, such as those with PCOS.
  • Lower Trigger Dose: Adjusting the HCG trigger shot can help reduce the risk of OHSS.
  • Elective Freezing of All Embryos: A frozen embryo transfer (FET) may be preferred over a fresh transfer in the hope of reducing chances of OHSS because the hormone levels will have stabilized.

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Conclusion

OHSS can be daunting, particularly for women navigating the emotional and physical aspects of IVF. Reaching out to a fertility specialist can provide personalised guidance, as you can then assess risk factors and develop an OHSS treatment plan suited to your needs. Having informed support during IVF can also help manage expectations and provide peace of mind throughout the journey. Understanding OHSS, especially for those undergoing IVF, allows them to be better prepared and aware of any potential complications.