Ovarian Hyperstimulation Syndrome

Many couples struggling with infertility choose to pursue IVF and IUI procedures in order to increase their chances of conceiving a child. If you have chosen to undergo one of these procedures, you may be given various fertility drugs to help stimulate your ovaries. Known as ovulation induction, this helps your ovaries to produce numerous egg follicles in preparation for ovulation. In the majority of patients, ovulation induction is safe and effective. However, this type of fertility treatment can sometimes result in a serious health complication, known as Ovarian Hyperstimulation Syndrome (OHSS). If left untreated, OHSS can lead to serious health side effects.

What is Ovarian Hyperstimulation Syndrome?
OHSS is a complication associated with ovulation induction. Ovulation induction is commonly performed with IVF and IUI infertility treatment procedures in order to increase your chances of conception. It uses specific types of fertility drugs (including Clomid and gonadotropins) to increase the number of follicles in your ovaries. Sometimes, however, too many follicles begin to develop in the ovaries, causing them to become swollen and enlarged. Known as OHSS, this syndrome can cause severe pain and trigger the release of fluid into the abdomen and lungs.

Types of Ovarian Hyperstimulation Syndrome
OHSS is classified according to its severity. There are three degrees of OHSS:


  • Mild: Mild OHSS occurs when your ovaries are swollen, but no bigger than five centimeters.
  • Moderate: Moderate OHSS occurs when your ovaries are swollen to a size between five and ten centimeters.
  • Severe: Severe OHSS occurs when your ovaries are swollen to a size greater than ten centimeters.


What Causes Ovarian Hyperstimulation Syndrome?
Know one is really sure why OHSS occurs. It is triggered by an abnormal reaction to ovulation inducers, particularly gonadotropin therapy. However, it remains unknown why some women react so severely to these types of fertility medications.

Who’s At Risk for Ovarian Hyperstimulation Syndrome?
Any woman undergoing ovulation induction is at risk for developing OHSS. The syndrome is relatively common, occurring in up to 10% of women undergoing IVF or IUI treatment procedures. However, it is rarely severe.

Certain factors do seem to increase your risk of developing OHSS. These risk factors include:


  • being under the age of 30
  • being underweight
  • having PCOS (polycystic ovarian syndrome)
  • having a previous incidence of OHSS
  • using high levels of hCG
  • using GnRH agonists


Symptoms of Ovarian Hyperstimulation Syndrome
The symptoms of OHSS vary depending upon how severe the condition is. Symptoms typically manifest four or five days after egg collection, and are often associated with pregnancy. Possible symptoms include:


  • nausea and vomiting
  • diarrhea
  • abdominal bloating and distension
  • abdominal pain
  • sudden weight gain (due to fluid accumulation in the stomach)
  • the appearance of cysts on the ovaries
  • difficulty breathing


Additionally, depending on the severity of your OHSS, you may experience reduced frequency in your urination as well as dark urine.

Complications of Ovarian Hyperstimulation Syndrome
If left untreated, OHSS can result in serious health complications. Severe cases of OHSS are rare, but they have been known to lead to permanent injury and even death. Possible complications include:


  • twisting of the swollen ovaries (which may require their removal and loss of fertility)
  • collection of fluid in the stomach and lungs (which interferes with bodily processes, including breathing)
  • loss of kidney and liver function
  • blood clots (which may lead to stroke)


Treating Ovarian Hyperstimulation Syndrome
Typically, OHSS symptoms will disappear on their own. However, if you are experiencing any of the symptoms of OHSS it is important that you inform your reproductive endocrinologist right away. She will perform an examination as soon as possible and recommend further treatment. Treatment may include:


  • monitoring symptoms such as weight gain and frequency of urination
  • reduction of activities, including sexual intercourse
  • removal of excess fluids in the abdomen
  • stopping hCG and other forms of infertility drugs
  • freezing of eggs or embryos for implantation later on


Steps to Prevent Ovarian Hyperstimulation Syndrome
If you decide to undergo ovulation induction, be sure that your reproductive endocrinologist is taking steps to monitor your progress. Careful monitoring can help to reduce your chances of developing OHSS in the first place. The best prevention techniques include:


  • frequent monitoring of your ovaries and follicular development using ultrasound
  • frequent testing of your blood estrogen levels



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