What is Ovarian Hyperstimulation Syndrome (OHSS)?
Ovarian Hyperstimulation Syndrome (OHSS) is a condition that sometimes occurs in women who are undergoing fertility treatments, particularly those involving hormonal stimulation of the ovaries. It results from an excessive response to fertility medications which leads to swollen, painful ovaries and, in severe cases, can cause serious health complications.
What Causes OHSS?
OHSS is primarily caused by the use of injectable hormonal medications that stimulate the ovaries to produce multiple eggs. These medications can lead to the release of a high number of eggs, which in turn can cause the ovaries to become swollen and painful. Elevated levels of human chorionic gonadotropin (hCG), either from fertility drugs or early pregnancy, can also exacerbate the condition.
What Are the Symptoms of OHSS?
The symptoms of OHSS can vary from mild to severe. Mild symptoms include bloating, mild abdominal pain, and mild nausea. Severe symptoms may include rapid weight gain, severe abdominal pain, persistent nausea and vomiting, decreased urine output, shortness of breath, and the development of blood clots. Severe OHSS requires immediate medical attention.
Who is at Risk for OHSS?
Several factors can increase the risk of developing OHSS, including:
- Young age (typically women under 35)
- Low body weight
- Polycystic ovarian syndrome (PCOS)
- High doses of fertility medications
- Previous instances of OHSS
- High levels of estrogen before the hCG trigger shot
How is OHSS Diagnosed?
Diagnosis is usually based on clinical symptoms and a physical examination. An ultrasound may be conducted to assess ovarian size and the presence of fluid in the abdomen. Blood tests can help evaluate kidney function, electrolyte levels, and hematocrit levels, which can indicate the severity of the condition.
What Are the Treatment Options for OHSS?
Treatment strategies for OHSS depend on the severity of the condition. Mild cases may resolve on their own with supportive care, such as increased fluid intake and pain relief. Moderate to severe cases may require hospitalization for IV fluids, electrolytes, and medications to reduce ovarian activity. In extreme cases, procedures to remove excess abdominal fluid (paracentesis) or surgery may be needed.
Can OHSS Be Prevented?
While it may not be entirely preventable, several strategies can reduce the risk of OHSS:
- Using the lowest effective dose of fertility medications
- Monitoring estrogen levels and follicle size frequently during treatment
- Adjusting medication doses or delaying the hCG trigger shot if necessary
- Considering the use of a GnRH agonist instead of hCG for ovulation triggering
What is the Prognosis for Women with OHSS?
The prognosis for women with OHSS is generally good, especially with early detection and appropriate treatment. Most women recover fully without long-term complications. However, severe cases can lead to significant health issues, including ovarian torsion, kidney damage, and thromboembolic events.
How Does OHSS Affect Future Fertility Treatments?
Women who have experienced OHSS may need to take additional precautions in future fertility treatments. This may include using lower doses of medications, opting for alternative stimulation protocols, or adopting a "freeze-all" strategy where embryos are frozen and transferred in a later, unstimulated cycle to avoid the risks associated with OHSS.
What Should Patients Do if They Suspect OHSS?
If a patient suspects they have OHSS, they should contact their healthcare provider immediately. Early intervention can help manage symptoms and prevent complications. Patients should also follow their provider's advice regarding hydration, activity level, and monitoring symptoms.
