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Ovarian Hyperstimulation Syndrome: Causes, Risks and Available Help to Handle the Symptoms

Brenda Albano

February 16, 2022

Ovarian Hyperstimulation Syndrome Causes, Risks and Available Help to Handle the Symptoms

Getting To Know Ovarian Hyperstimulation Syndrome

Pregnancy is an exciting and thrilling experience in a woman’s life. There may be some unexpected turns and twists before, during, and after pregnancy. To have a safe and trouble-free pregnancy, you must exercise caution throughout the reproduction cycle. Women who are TTC – trying to conceive are aware of the importance of ovarian health for a successful pregnancy and delivery. Ovarian hyperstimulation syndrome is something they want to avoid.

Let’s define what ovarian hyperstimulation syndrome is and how it relates to women’s reproductive health.

What Is Ovarian Hyperstimulation Syndrome?

Ovarian hyperstimulation syndrome or OHSS is not a disease in and of itself. It is a side effect of some fertility treatments, particularly in-vitro fertilization. The IVF process is carried out by stimulating egg production. The eggs are later extracted and fertilized in the lab. Finally, the fertilized eggs are returned but this time to the women’s uterus.

During this treatment cycle, different fertility medications including injectable drugs are taken to enhance pregnancy hormones. Some women experience OHSS as a side effect. OHSS which is an exaggerated reaction to excessive pregnancy hormones. In OHSS, you may feel pain and swelling in your ovaries. In some cases, fluid leaks into the abdomen and causes discomfort. Make sure you have a conversation with your doctor and read all literature available. Only a certain number of courses of fertility drugs are allowed in a row or over a lifetime. Make sure your doctor is aware and in agreement of not only when to start these fertility treatments but also when to put a stop to them.

Several studies have found that women who have polycystic ovary syndrome are more likely to develop OHSS. This can be avoided, however, by closely monitoring the HCG hormone levels during treatment and strictly adhering to the instructions given by your healthcare provider; including the packaging instructions and warnings of the fertility drugs.

How Common is Ovarian Hyperstimulation Syndrome?

Mild OHSS is quite common. Research suggests that almost 33 percent of American couples have tried fertility treatments. Of that number, 3 percent of couples tried advanced reproductive techniques (ART) to conceive. The in-vitro fertilization process is one of the most common advanced reproductive techniques.

Previous research has revealed that almost 20 to 33% of women undergoing in-vitro treatment are likely to suffer from ovarian hyperstimulation syndrome, but most of these cases are mild or moderate. Symptoms that accompany moderate and mild OHSS may be resolved with small changes in your routine and may not require any medication.

Studies show that less than 1% of women experience severe cases of OHSS. Severe cases are very rare but they can be fatal if not treated properly. No one expects to be part of the 1% (if it really is that low) so do your homework before considering such a big step. Consider natural supplementation and dietary / lifestyle changes before entering into such an expensive and oftentimes, dangerous world of IVF.

Ovarian Hyper-stimulation Syndrome Causes

The exact causes of OHSS are not fully understood yet. Many health experts believe that it is a complication of fertility treatments. Mostly, OHSS develops due to the abundance of the pregnancy hormone HCG (human chorionic gonadotropin). During fertility treatments, in some women HCG level rises abnormally and ovarian response exceeds that aimed for and ovarian blood vessels begin to leak fluid into the abdomen.

Sometimes in infertility treatments, HCG may be injected as a “trigger shot” to assist mature follicles in releasing its egg. If you become pregnant during treatment, your body may begin to produce HCG in response to the pregnancy, which could be dangerous. As a result, the HCG level can rise exponentially.

OHSS typically develops within a week of the fertility medications being injected. It is estimated that nearly one out of every three women is at risk of developing ovarian hyperstimulation syndrome. According to some recent studies women with PCOS (polycystic ovaries syndrome) are more likely to get OHSS when undergoing fertility treatments.

Ovarian Hyperstimulation Syndrome Symptoms

Ovarian hyperstimulation syndrome can be mild, moderate, or severe. The signs and symptoms may differ depending on the patient and the severity of the problem. For moderate cases, some of the most common symptoms of OHSS may include:

Abnormal weight gain and inflammation in the area of your ovaries. The symptoms can get worse if you get pregnant during the OHSS. Ovarian hyperstimulation disorder often complicates pregnancies because its symptoms take weeks to diminish. In severe cases of OHSS, weight gain comes on suddenly.

In addition to gastrointestinal issues, decreased urination is also a symptom of severe OHSS. Urination levels can drop dramatically and you may become dehydrated or experience high pressure in your abdomen.

Some studies have linked shortness of breath to the symptoms of OHSS. Patients suffering from OHSS may find it difficult to walk more than 12 to 13 steps.

In severe cases of OHSS, blood clotting occurs in many body parts, especially in the legs. If you’re experiencing any of these symptoms, it’s time to see your doctor or midwife; immediately.

What are the Risks of Ovarian Hyperstimulation Syndrome?

As previously stated, not all women receiving fertility treatments are at risk of developing ovarian hyperstimulation disorder. However, certain risk factors may influence your chances of developing OHSS symptoms. Your risk of suffering from OHSS may increase:

  • If you have a history with OHSS
  • If you have any symptoms of PCOS
  • You have high estrogen levels during IVF
  • Receiving more than required dosage of HCG “trigger shot” You are receiving a higher-than-necessary dose of HCG “trigger shot”
  • You are thin and underweight
  • Your age is less than 35

Ovarian hyperstimulation syndrome is generally regarded as an ‘iatrogenic’ disorder which means it is a side effect of certain hormone therapies that increase fertility.

Low doses of injectable hormones prescribed by your doctor may lower your risk of OHSS. Furthermore, careful monitoring of risk factors may help to reduce the risk of OHSS. Although OHSS occurs after ovulation certain variables can raise the risk factors. For example, if ovaries react abnormally to fertility medications and produce a large number of follicles, it could be an indication that your chances of developing OHSS symptoms during this cycle are high.

Considering these risk factors, your doctor may delay your treatment cycle and ask you to avoid sexual intercourse until the symptoms go away. Sometimes, due to high risk, doctors adopt ‘coasting’. It is a procedure to delay your ovulation by a few days to ensure a successful pregnancy.

What Does OHSS Feel Like?

Normally, ovarian hyperstimulation syndrome symptoms and signs are minor and may be managed with proper treatment and care. If you have recently undergone some fertility treatment, you may feel some abdominal pain, nausea, and instant weight gain in case of mild OHSS.

In the case of mild OHSS, some women may notice small abdominal swelling and discomfort. Moreover, loss of appetite, diarrhea, and feeling of bloating are also symptoms of moderate OHSS.

In severe cases of OHSS, you may have dark-colored urine and feel dehydrated. . The need to urinate may also decrease. If suffering from OHSS, you may feel difficulty in breathing even after a small walk.

It is important to remember that you may feel these symptoms within one week of receiving fertility treatment. In the case of the in-vitro retrieval process, OHSS signs may appear four to five days after egg collection.

Some studies have linked OHSS with many health complications such as blood clotting in the lungs and legs. Rarely, the ovarian cyst formed due to OHSS can burst and fluid starts to bleed into your body. In this case, you may require surgery to stop harmful fluid seepage into the abdomen as in worst cases it can lead to a miscarriage.

Ovarian Hyperstimulation Syndrome Treatments

In the case of mild and moderate OHSS, symptoms normally clear up on their own. Often, these symptoms take a week or two to completely disappear. The available treatment options depend upon the severity of the situation.

Treatments for mild to moderate OHSS are focused on relieving distress and avoiding complications. For mild OHSS symptoms here are some things you can do at home that may help to handle the symptoms:

1. Stay Hydrated

Studies suggest that increasing your fluid intake may help to relieve moderate OHSS symptoms. It is recommended that you drink at least 10 to 12 glasses of water daily. Other drinks with electrolytes such as Gatorade may be a good choice to help handle the symptoms.

2. Keep your calm and Take Rest

Get plenty of rest and do not overexert yourself. It’s also recommended to keep up with light activities because complete bed rest can lead to some complications.

3. You may take simple painkillers

In moderate OHSS cases, if your pain level is considerable, it is suggested that you may take some over-the-counter painkillers to relieve the situation.

4. Avoid caffeine and Alcohol

In the case of moderate and severe OHSS, alcohol and caffeinated drinks are dangerous to consume.

However, managing severe OHSS cases requires keeping patients under intense care and they may have trouble staying hydrated or pain levels may increase dramatically. In these cases, Intravenous (IV) fluids are injected to assist hydration, and paracentesis is recommended to remove excess fluids from the abdomen.

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