There are many parts to the IVF process, and some of them cause adverse effects, like OHSS. If you’re about to go through IVF, it’s important to be aware of potential side effects. If you want to learn more about Ovarian Hyperstimulation Syndrome, keep reading!

Read more: Egg Donation

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Ovarian hyperstimulation syndrome is a bodily response to the excess hormones that are taken during in vitro fertilization. Women are often given progesterone and estrogen during the IVF process to stimulate the uterus and support the implanted embryo. The excess hormone levels can cause the ovaries to become painful and swell. 

OHSS can also occur during any time that you’re taking injectable medications, not just during fertility treatments. It’s rare, but OHSS can also occur when taking oral fertility medications like clomiphene. 

What Causes OHSS?

While Ovarian Hyperstimulation Syndrome can be quite common for women undergoing fertility treatments, the cause is not entirely understood. The excess hCG levels in the body play a critical role in OHSS, as the blood vessels in the ovaries react to the hormones and leak fluid. The leaking fluid causes inflammation in the ovaries and, if severe enough, will travel to the abdomen.

Read more: Frozen Embryos

During a fresh embryo transfer, the patient is typically given an hCG trigger shot to support the potential pregnancy. If you develop OHSS, it will typically be within a week of the hCG trigger shot. If you do become pregnant during this time, the OHSS may become more severe if your body begins to develop hCG naturally. 

OHSS may also occur in women who aren’t undergoing fertility treatments as a spontaneous condition. 

Read more: Fresh Egg Donation

How Common is OHSS?

As many as 33% of IVF patients will experience mild OHSS symptoms. Severe OHSS is quite rare, affecting just 1% of fertility patients. Women who are at a higher risk for OHSS may suffer from PCOS, be under 30, have become pregnant after the IVF treatment, or have previously had OHSS. 

What are the Symptoms of OHSS in IVF?

If you’re partaking in IVF treatments and you have used injectable medications to help the process along, you may experience some symptoms of OHSS within a week of taking them. It can take up to two weeks in some cases for symptoms to fully manifest. There are mild, moderate, and severe cases of OHSS, and the symptoms vary depending on the severity. 

OHSS is diagnosed through a physical exam to check the swelling around the abdomen, through ultrasound or x-ray, and blood tests. 

Mild/Moderate OHSS Symptoms

So, what are some of the mild and moderate OHSS symptoms you may want to watch out for?

Abdominal Pain During IVF Stimulation

Since the ovaries become inflamed and can leak fluid, it can become painful in the abdominal region. It can lead to increased mild weight size and some bloating. 

Bloating During IVF Stimulation

Bloating can also occur when the ovaries are inflamed. 

Nausea During IVF Stimulation

A common symptom is nausea and vomiting as a result of the excess hormones and changes in the ovaries. 

Severe OHSS Symptoms

OHSS can develop into a more serious condition, requiring medical intervention. The following are more severe OHSS symptoms.

Severe Abdominal Pain During IVF Stimulation

If you’re experiencing severe abdominal pain, are bloated, or have gained over 2.2lbs in 24 hours, it’s crucial to seek emergency medical attention. Having a tight or enlarged abdomen is another symptom of severe OHSS. 

Severe Nausea During IVF Stimulation

Persistent nausea and vomiting may occur during severe OHSS. A hospital stay can help ensure you’re keeping hydrated. 

Difficulty Breathing During IVF Stimulation

When the ovaries are leaking, and if they are producing a lot of fluid, it’s possible that the fluid can travel to the chest, causing difficulty breathing or shortness of breath. Having a chest x-ray done is one of the many ways your doctor can diagnose OHSS. 

Decreased Urination During IVF Stimulation

Notify your doctor right away if you’re finding that you aren’t urinating as frequently as you are used to. 

Blood Clots: Leg and/or Chest Pain During IVF Stimulation

If you are experiencing leg or chest pain after IVF treatment, you require immediate medical attention, as you are at increased risk for a blood clot. 

What is the Treatment for OHSS?

Depending on how severe the OHSS is, treatment options will vary. If you’re experiencing a mild form of OHSS, it may improve on its own. However, if you’re experiencing severe symptoms, you may need to spend some time in the hospital. Typically, symptoms only last around one to two weeks if you’re not pregnant, so management of OHSS can be doable. 

Mild to moderate OHSS can be resolved with:

  • Blood tests to monitor electrolytes, hydration levels, and other key metrics
  • Increased fluid intake and rest
  • Measuring urine production
  • Anticoagulant medications
  • Drainage of fluid in the abdomen with a needle

Severe OHSS treatments may include:

  • Hospitalization with IV fluids
  • Cabergoline, gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara)
  • For extreme cases, surgery may be required
  • Anticoagulant medications

How Long Does OHSS Last?

OHSS symptoms will typically last around 7 to 10 days. If you’re undergoing IVF and your treatment does not produce a pregnancy, you should find relief from OHSS symptoms by your next period. If you become pregnant, you can expect symptoms to last a little longer due to the increased hormone levels. 

What are the Risk Factors for OHSS?

Ovarian Hyperstimulation Syndrome can occur without any risk factors present, but some of the known factors include: 

  • Under 35 years old
  • Low body weight
  • High number of follicles 
  • PCOS
  • Previously experienced OHSS
  • Increased levels of estrogen

Can OHSS Be Prevented?

Some women are more prone to OHSS than others, but some strategies help prevent OHSS. Discuss your concerns with your doctor, and they can create a personalized plan of action for your fertility treatments. Carefully monitoring your treatments, cycles, follicles, and hormone levels will help you know where you stand. 

To prevent OHSS, you may:

  • Consider freezing your embryos. When you transfer a frozen embryo, you don’t require the hCG trigger shot, which will lower the hormone level in your body. Freezing your embryos also allows you to try again later if your body isn’t ready. 
  • Consider adjusting or adding medication. Using the lowest possible dosage of gonadotropins can still trigger ovulation and stimulate the ovaries without causing OHSS. You may also add in additional medications that can help reduce the risk of OHSS while not affecting the chances of becoming pregnant. These medications include calcium infusions, dopamine agonists, and a small dose of aspirin. Those who suffer from PCOS may see prevention with metformin during ovary stimulation. 
  • Stop injectable treatments. Known as ‘coasting,’ when your estrogen levels are high, or you have a significant number of follicles that are developed, putting a pause on injectable medications can help reduce the risk of OHSS. 

With the support of the best professionals around the world, ELITE IVF can support you through the IVF process, including preventing or navigating OHSS. The best way to avoid OHSS is to have a good treatment plan and doctors who care for you and who will monitor you closely. If you’re ready to learn about IVF, we’re ready to help you every step of the way. Contact us today.