OHSS (Ovarian Hyper Stimulation Syndrome)

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Ovarian Hyper Stimulation Syndrome (OHSS) is a condition in which ovaries give exaggerated response to Ovulation Induction, process to get multiple eggs in a single cycle. 

If ovaries are not able to handle the hormones injected to produce more eggs, hyperstimulation takes place, which causes patient’s ovaries to swell and causes a lot of pain apart from other symptoms.

It is more likely to happen when injectable hormones used for In Vitro Fertilization (IVF). It rarely happens with tablets used for Ovarian Induction.

Treatment depends on severity of the disease.

What are the symptoms of OHSS?

Less than 5% of the females receiving hormonal fertility treatment develop OHSS, of which less than 1% of females develop severe symptoms. 

Symptoms of OHSS range from mild to severe and they start showing up within one to two weeks of starting of hormonal injection.

Mild to moderate OHSS

· Nausea

· Vomiting

· Mild abdominal pain 

· Abdominal bloating 

· Diarrhoea

· Pelvic tenderness 

Severe OHSS

· Severe abdominal pain 

· Severe & persistent nausea & vomiting 

· Decreased urination 

· Severe bloating & fluid collection in abdominal cavity 

· Shortness of breath 

· Sudden weight gain around 1kg in 24 hours 

Causes of OHSS 

Though not fully understood, OHSS is a response to increase in HCG hormone in body. The increase in HCG could be due to :

External – injections given at the time of maturation of oocyte as a trigger or 

Internal – body itself producing more HCG due to pregnancy.

Ovarian blood vessels start leaking & fluid moves into abdominal & pelvic cavity due to response to hormone HCG.

Risk factors 

Factors which are known to increase the chances of OHSS include: 

Complications 

Complications occurring due to OHSS can be managed carefully with proper treatment plan. Only in rare cases they become life threatening. 

  • Fluid collection in abdominal cavity sometimes in chest 
  • Breathing difficulty
  • Electrolyte disturbances 
  • Renal failure 
  • Ovarian Torsion 
  • Rupture of ovarian cyst 
  • Blood clots in large vessels 
  • Pregnancy loss form miscarriage or termination of pregnancy as a treatment 
  • Rarely death 

How to prevent OHSS 

  • Adjusting the dose of hormonal injections.
  • Addition of medicines like Aspirin, cabergoline, metformin, high protein intake along with intravenous protein & starch infusion.
  • Retrieve embryo and freeze, then giving Gn-RH antagonist injection to reduce estrogen which got increased due to Ovulation Induction. This brings OHSS under control by the time of next ovulation cycle. Now frozen embryo can be put in if OHSS has subsided or wait till next cycle.

Diagnosis 

Diagnosis can be done by 

  • Physical examination – pelvic tenderness & bloating can be diagnosed 
  • Ultrasound – both abdominal & transvaginal sonography is done to diagnose fluid level in abdominal & pelvic cavity along with ovarian cyst sizes.
  • Blood tests – to check renal function, blood clotting time & serum electrolytes 

Treatment plan in OHSS

  • Increase fluid intake.
  • Frequent physical examinations & sonography.
  • Watch on urine output.
  • Blood tests to monitor electrolytes, blood clotting & dehydration.
  • Drainage of excessive abdominal fluid.
  • Intravenous supplements of protein & starch.
  • Anticoagulants to prevent clotting.
  • Suppression of ovarian activity by Gn-RH antagonist or tab letrozole.
  • Surgery is required in cases of complications like Ovarian Torsion & Cyst Rupture.

Lifestyle & Home remedies 

  • Avoid sexual intercourse
  • Maintain light physical activity, no strenuous exercise 
  • Take pain killer by physician’s opinion 
  • Daily weight monitoring 
  • Increase fluid intake & take high protein diet 

Conclusion 

OHSS is a side effect occurring during hormonal infertility treatment due to hyperstimulation of ovaries.

It happens in very few cases, but is very dreadful, hence should be diagnosed early & managed properly.

We are proud to announce that Akruti IVF is an OHSS free clinic i.e. we have managed to keep OHSS completely under control by good monitoring of cycles, using perfect protocols for freezing of embryos with vitrification.

Cryopreservation of embryos by vitrification & transferring in next cycle is giving excellent success rate even if OHSS was encountered during conception.