What is Ovarian Hyperstimulation Syndrome (OHSS)?
Ovarian Hyperstimulation Syndrome (OHSS) is a medical condition that can occur in women who are undergoing fertility treatment, particularly those involving hormonal medications to stimulate the ovaries. The condition arises when the ovaries respond excessively to these medications, leading to swollen and painful ovaries.
What Causes OHSS?
OHSS is most commonly triggered by the use of injectable fertility medications containing human chorionic gonadotropin (hCG) and gonadotropins. These medications are designed to stimulate the production of multiple eggs in the ovaries, but in some women, the response can be excessive, leading to the symptoms of OHSS.
What Are the Symptoms of OHSS?
Symptoms of OHSS can range from mild to severe and usually develop within a week after ovulation or egg retrieval. Mild symptoms include bloating, mild to moderate abdominal pain, nausea, and diarrhea. Severe symptoms can include rapid weight gain, severe abdominal pain, vomiting, shortness of breath, and decreased urination.
How is OHSS Diagnosed?
The diagnosis of OHSS is primarily clinical, based on the patient’s symptoms and a physical exam. A transvaginal ultrasound may be used to assess the size of the ovaries and the presence of fluid in the abdomen. Blood tests can also help evaluate kidney function, electrolyte levels, and red blood cell concentration.
Who is at Risk for OHSS?
Certain factors can increase the risk of developing OHSS. Women with polycystic ovary syndrome (PCOS), those with a high number of follicles, and women under the age of 35 are at higher risk. Additionally, high levels of estradiol or a previous episode of OHSS can also increase the risk.
How is OHSS Treated?
The treatment of OHSS depends on the severity of the symptoms. Mild cases usually resolve on their own and can be managed with rest, increased fluid intake, and over-the-counter pain relief. Moderate to severe cases may require hospitalization for intravenous fluids, pain management, and careful monitoring of fluid balance and electrolyte levels. In life-threatening situations, interventions such as draining excess fluid from the abdomen may be necessary.
How Can OHSS Be Prevented?
Preventive strategies include careful monitoring of ovarian response during fertility treatment, adjusting medication dosages, and considering alternative protocols such as the use of a gonadotropin-releasing hormone (GnRH) agonist trigger instead of hCG. In some cases, elective embryo freezing (cryopreservation) and delaying embryo transfer can be beneficial.
What Are the Long-Term Effects of OHSS?
Most women recover from OHSS without long-term consequences. However, severe cases can lead to complications such as ovarian torsion, kidney damage, and blood clots. It is crucial for women who experience OHSS to receive appropriate medical care to minimize these risks.
When Should You Seek Medical Attention?
Women undergoing fertility treatment should be vigilant about the symptoms of OHSS. Immediate medical attention is necessary if symptoms escalate rapidly or if severe symptoms such as difficulty breathing, severe abdominal pain, or reduced urine output occur.
