It is important for you who are undergoing fertility treatment to know about this! (Ovarian Hyperstimulation Syndrome - OHSS)

Fertility treatments are becoming increasingly common these days to help you achieve your dream of having a baby. This journey can be both exciting and a bit overwhelming. It's important for you and your partner to be aware of the complications that can sometimes occur with these treatments. Today, we're talking about a condition that can often be associated with fertility treatments, but is now largely manageable. That's Ovarian Hyperstimulation Syndrome, or OHSS for short.

Simply put, what is OHSS?

Okay, let's put it this way. Normally, a healthy woman's ovaries release only one egg during her monthly menstrual cycle. But if you're having trouble conceiving, especially if you're undergoing a treatment like IVF (In Vitro Fertilization) , your doctor will give you hormonal medications to stimulate your ovaries and make them develop multiple eggs at once.

Ovarian Hyperstimulation Syndrome (OHSS) is a condition where your ovaries become overly sensitive to the hormone medications and overreact. When this happens, the ovaries swell and begin to leak fluid into the abdomen. This is simply called OHSS.

In the past, this was a relatively common complication of IVF treatment. However, with the new treatments and techniques available, the incidence of this condition has decreased significantly. However, mild OHSS is still occasionally seen.

What are the symptoms of OHSS? How do we recognize it?

The symptoms of OHSS can vary from person to person. They also vary depending on the severity of the condition. Typically, these symptoms can begin to appear within a week of using the medication to stimulate ovulation. Sometimes it can take up to two weeks.

It is very important for you to clearly distinguish and recognize these symptoms.

Why does this OHSS occur? What is the cause?

The main cause of OHSS in most cases is the hormone HCG (human chorionic gonadotropin) . This is the main hormone that helps maintain pregnancy.

During the IVF treatment process, your doctor will give you a "trigger shot" containing the hormone HCG before the eggs are collected to help the developed eggs mature properly.

Now imagine, when you give this HCG injection at a time when you have many follicles in your ovaries, the ovaries can over-react to it. Because of that over-response, fluid starts leaking from the blood vessels around the ovaries. When this fluid accumulates in the abdominal cavity, the aforementioned symptoms of bloating and pain occur.

Who is most at risk for this condition?

Not everyone gets OHSS, but some people are at a slightly higher risk.

• Women with PCOS: Because their ovaries have a large number of follicles, they are more responsive to hormonal stimulation.
• Those who have experienced OHSS before: If you have had it once, there is a small chance that it will happen again.
• Those who develop a large number of follicles or have very high estrogen hormone levels during IVF treatment: This is something your doctor will monitor with scans and blood tests.
• Those who received high doses of the hormone HCG.
• Those undergoing a "fresh" embryo transfer: This is because if a pregnancy occurs during the same cycle in which the ovaries were stimulated, the pregnancy will naturally increase the body's production of HCG. This can make OHSS worse or last longer. This is why doctors will freeze the embryos and transfer them at a later date if there is a risk.
• People under 30 years of age and underweight: There is an opinion that this may also be a risk factor.

Are complications of OHSS dangerous?

Although most cases of OHSS are mild, in rare cases, serious complications can occur. It is important to be aware of this.

• Blood clots (Thrombosis): Blood clots can form in the lungs or legs. Your doctor will give you medication to reduce this risk.
• Ovarian cyst rupture: This is a very rare occurrence. If it does happen, it can cause heavy bleeding and may require surgery to stop it.
• Impaired kidney function.
• Severe difficulty breathing.

How does a doctor diagnose OHSS?

After asking about your symptoms, the doctor will perform several tests to confirm the condition.

1. Physical examination: Your weight will be checked, your abdominal circumference will be measured, and the degree of swelling will be assessed. A pelvic exam is not usually performed at this time because the ovaries are swollen and sensitive.

2. Ultrasound scan: This helps to see if there is free fluid in the abdomen and the size of the ovaries.

3. Blood tests: This is important to check your hormone levels, kidney function, and blood density.

4. Chest X-ray: This is done to check for fluid accumulation in the chest and if there is difficulty breathing.

What are the treatments for this?

Treatment depends on the severity of your condition. The main goal is to control symptoms and prevent complications.

Are there ways to prevent OHSS?

While some cases cannot be prevented, your doctor will assess your risk based on your health history and test results. They will take several steps to reduce your risk.

• Adjusting the dose of your hormonal medication: If the risk is high, you may start with a lower dose.
• Avoiding the HCG "trigger shot": A different drug (agonist trigger) can be used instead.
• Freezing embryos: Eggs are collected, embryos are developed, and frozen. Then, after the ovaries have returned to normal, the embryos are transferred into the uterus in one to two months. This is the most effective way to prevent OHSS.
• Coasting: If the ovaries appear to be overstimulated, hormone injections are stopped for a few days before the HCG injection.

If you have any questions about this, don't be afraid to ask your doctor. This is all for your safety.

OHSS is a condition that can occur during fertility treatments, but is now largely manageable. It is temporary. Symptoms usually go away within a week or two. The most important thing is to stay in regular contact with your medical team and let them know about any symptoms.

OHSS, Ovarian Hyperstimulation Syndrome, IVF, Fertility, Childbirth, Women's Health, PCOS, Ovaries, Hormone Treatment