OHSS risk and cancellation
3 Replies
Staci - January 24

Dear Dr. Jacobs,

My most recent IVF attempt was just canceled yesterday on Day 11 of stims. To my knowledge everything had been going fine along the way but, yesterday, I was told I had over 20 follicles, an E2 level of 4000 and that, since the majority of my follicles were in the 12 to 13mm range, I would need another night of stims if they were to proceed. They felt that would raise my E2 level higher. They canceled my cycle as they were too worried about OHSS developing. I was quite devastated as, at the very least, I would have hoped they would just do the retrieval then freeze all the embryos for later transfer.

At any rate, my question is now I'm still feeling rather sore and uncomfortable with all of these follicles and no retrieval. How long will this situation take to resolve?
How long is one usually advised to wait between cycles after something like this? I'm just worried that I will inevitably have cysts as a result of this.

Please let me know if there are any complications to just not doing the retrieval at this late a stage.

Thank you,

Staci

 

Barry Jacobs, M. D. - January 25

It will be a few weeks before the cysts resolve. You may have residual cysts after your next flow, but they should be gone by your following cycle. Infrequently, the weight of the cysts can cause an ovary to twist on its blood supply, while you are standing or sitting. You can lose an ovary that way. Lying down usually removes the pressure, and the problem.
Good luck.

 

Staci - January 26

Dr. Jacobs,

Thank you for the quick reply.

Could you just let me know if, in your experience, it is unusual to have a cycle canceled in this type of circumstance?

As stated previously, I was going into Day 12 of stims with a little over 20 follicles; the majority of which seemed to be in the 12 to 13 range but with one 17 and two 16's. Apparently, I would have needed one more night of stims. My E2 level was 4,000 that day and they felt it could hit 5,000 by the following day after another night of the medications.

I've scoured the internet for similar cases and can't seem to find any so either I'm not using good search terms or it just doesn't happen very frequently (or ever?!). I'm just getting the impression that most RE's would go ahead with the retrieval but just freeze everything as the most prudent course of action. It just seems like canceling the cycle entirely at such a late point in the game is very extreme?

Based on the information I've provided, do you see any reason why coasting wouldn't have been an option?

Thanks for your opinion.

Staci

 

Barry Jacobs, M> D. - January 27

I do not have statistics to answer your question. In my own practice, I have had to cancel an IVF cycle 1 or 2 times a year, for the response your ovaries exhibitted.
Good luck.

 

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