If you are undergoing fertility treatments in hopes of having a baby, you may have some fears and concerns, right? That's normal. It's important to be aware of the potential side effects of these treatments. One such condition that is not common for most people, but is good to know about, is called Ovarian Hyperstimulation Syndrome (OHSS) . Today, we'll talk about it in a simple, easy-to-understand way.
What exactly is OHSS?
Simply put, OHSS is when your ovaries swell and leak a fluid-like substance into your abdomen. This is often caused by hormonal medications that stimulate your ovaries to produce multiple eggs at once to help you conceive.
Normally, a healthy woman releases only one egg during her monthly menstrual cycle. However, for those who are having difficulty conceiving, especially during treatments like `(IVF)` (In Vitro Fertilization), hormonal drugs are given to stimulate the ovaries before egg retrieval. Sometimes, the ovaries overrespond to these drugs. That's when OHSS can occur. This is also most commonly seen with injectable hormonal drugs.
In the past, OHSS was quite common among those undergoing IVF treatment. However, with new protocols and strategies, this condition has decreased significantly. However, there are still cases of mild OHSS from time to time.
Women with polycystic ovary syndrome (PCOS) , or those with an overabundance of eggs, are particularly at risk for OHSS, as PCOS is a reproductive disorder associated with hormonal imbalance.
What are the main types of OHSS?
OHSS can be classified as mild, moderate, and severe . Your doctor will classify it based on how severe your symptoms are. Most of the time, OHSS is mild and the discomfort it causes is temporary. However, severe OHSS is rare, but it can be life-threatening.
According to current data, less than 5% of women undergoing ovarian stimulation for IVF experience OHSS. Previously, this was around 10%. Severe OHSS occurs in less than 1%.
What are the symptoms of OHSS?
The symptoms of OHSS can vary from person to person, and they also vary depending on the severity of the condition. In most cases, symptoms begin within a week of using medications to stimulate ovulation. However, sometimes symptoms may not appear for up to two weeks.
Symptoms of Mild to Moderate OHSS:
- Abdominal pain.
- Bloating. A feeling as if the stomach is full of air.
- Slight weight gain, such as gaining more than one kilogram (2 pounds) in one day.
- Nausea. Feeling like you're going to vomit.
Severe OHSS may cause symptoms such as:
- Excessive weight gain.
- Severe nausea and vomiting.
- Severe abdominal swelling.
- Difficulty breathing.
- Blood clots.
- Decreased urination.
- Severe abdominal pain.
The most important thing is that if you experience any of these symptoms while you are undergoing fertility treatment, you should tell your doctor immediately. Your medical team will be monitoring you regularly and will be able to tell you if you are at risk of developing OHSS based on your estrogen levels and the number of follicles seen on ultrasound scans. Most of the time, these are mild conditions that resolve on their own. However, it is best to talk to your doctor about your symptoms.
Why does this condition called OHSS occur?
Most of the time, OHSS occurs because a hormone called `HCG (Human Chorionic Gonadotropin)` stimulates your ovaries. Normally, your ovaries produce only one egg at a time. However, hormone treatments stimulate the ovaries to develop many eggs at once. Women undergoing `(IVF)` treatment are given a ``trigger shot`` of `HCG` to mature the eggs before they are collected. So, when many potential eggs develop, the ovaries can overreact to this `HCG` hormone. That's when OHSS occurs.
In OHSS, these fertility drugs cause fluid to leak from the blood vessels around the ovaries. Sometimes this fluid can collect in the abdominal cavity, causing symptoms such as swelling and pain.
Who is at higher risk of developing OHSS?
People at higher risk of developing this condition include:
- Women with `PCOS` (polycystic ovary syndrome).
- Those who have previously developed OHSS.
- Those who had a large number of follicles or high estrogen levels during IVF stimulation.
- Those who received high doses of the hormone HCG during their IVF cycle.
- Those who have had a "fresh" embryo transfer (if they get pregnant while their ovaries are still stimulated, that pregnancy can lead to prolonged OHSS). This means that the risk is higher than with a "frozen" embryo transfer.
Also, although there is no clear evidence, there is a belief that the following people may also be at slightly increased risk of OHSS:
- Young women under 30 years of age.
- People who are underweight.
What are the possible complications of OHSS?
Women with OHSS are at risk of developing blood clots in the lungs or legs (thrombosis) . Medications can be given to reduce this risk. There may also be an increased risk of stroke. If you experience leg pain, swelling, or chest pain, you should tell your doctor immediately.
Very rarely, an ovarian cyst associated with OHSS can rupture and cause serious bleeding. In this case, surgery may be necessary to stop the bleeding.
How do doctors diagnose OHSS?
Doctors perform several tests to diagnose OHSS. These include:
- Physical exam: Your weight will be checked, your waist circumference will be measured, and you will be checked for signs of swelling. However, a pelvic exam will not be done at this time. This is because the ovaries are swollen and could burst if pressure is applied.
- Ultrasound: This can check for free fluid in the abdominal cavity and the size of the ovaries.
- Chest X-ray: To check for fluid buildup in the chest.
- Blood tests: Measure hormone levels that indicate signs of OHSS.
What are the treatments for OHSS?
Treatment for OHSS depends on the severity of the condition. The main goal of treatment is to control symptoms and prevent complications. Mild cases of OHSS usually resolve on their own within a week or two. However, if you get pregnant during the same cycle, symptoms may persist for a while.
Common treatments for mild to moderate OHSS include:
- Avoid strenuous physical activity. Avoid things like running, jumping, or lifting weights.
- Drinking electrolyte-rich fluids, such as Jeevani, or perhaps the doctor's drink ``(Gatorade®)``.
- Using medications like paracetamol (Acetaminophen) to reduce pain.
- Weighing yourself every day.
- Always be on the lookout for any serious symptoms.
Severe OHSS often requires hospitalization. Treatment for severe OHSS may include:
- Intravenous (IV) fluids. That means giving things like saline.
- Undergoing a procedure called paracentesis. This is done to remove excess fluid that has accumulated in the abdomen.
- Giving medications to relieve symptoms or reduce ovarian function.
- Giving blood thinners to reduce the risk of blood clots.
Sometimes you may need to stay in the hospital for supportive care and close monitoring until your symptoms improve.
How long does it take to recover from OHSS?
The time it takes to recover from OHSS varies depending on the severity of the condition and whether you got pregnant during that cycle. Your doctor will tell you when you can return to normal activities and what to expect.
"Is there a way to get rid of OHSS quickly?" you may be wondering. There really is no one-size-fits-all solution. Treatment depends on the severity of your symptoms. So, your doctor is the best person to talk to about treatment options.
Can OHSS be prevented?
Some cases of OHSS cannot be prevented. However, your doctor can tell if you are at risk based on your health history and blood test results. During fertility treatment, your doctor will regularly monitor your ovaries to reduce your risk of OHSS. This will include blood tests (to check hormone levels) and ultrasound scans (to check how well your ovaries are developing).
There are several ways your medical team can help you prevent OHSS (or minimize symptoms):
- Reducing or adjusting medication dosage.
- Avoid giving the `HCG` "trigger shot" during treatment.
- Changing fertility medication type.
- Freezing your embryos and delaying embryo transfer until your ovaries return to normal.
What happens if OHSS occurs? Is it a problem getting pregnant?
OHSS is a temporary condition. It usually goes away within two weeks. Even in severe cases, early treatment can lead to good results. The important thing is that if you get pregnant after successful fertility treatment, OHSS will not harm your pregnancy. Your symptoms will gradually go away and will not affect your pregnancy. So don't worry about it.
When should I see the doctor?
If you are undergoing fertility treatment and you experience any symptoms of OHSS, see your doctor immediately.
What questions should you ask the doctor?
If you have OHSS, you can ask your doctor these questions:
- How bad is my condition?
- What treatment options do I have?
- What signs of complications should I look out for?
- Will OHSS harm my ability to get pregnant or the fetus?
It is normal for some people to feel some discomfort after egg collection. Bloating, light spotting, and feeling full are common side effects of IVF. OHSS is a rare complication of IVF treatment.
Finally, take-home message:
If you're expecting a baby, you may be a little scared to learn about OHSS. But remember, OHSS is now a condition that can often be prevented and, if mild, managed well. The most important thing is to stay in touch with your doctor and let them know about any discomfort you're experiencing.
During fertility treatments like IVF, doctors monitor you very closely. So, if there is a risk of OHSS, they can identify it early and take necessary steps. Talk to them about any questions or concerns you may have. It will be a great help for a healthy journey!
` OHSS, Ovarian Hyperstimulation Syndrome, Fertility, IVF, Ovaries, Hormones, Pregnancy
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