The ovarian hyperstimulation syndrome

Description

The ovarian hyperstimulation syndrome is an exaggerated response to an excess of hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. The ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful.

the ovarian hyperstimulation syndrome (OHSS) may occur in women undergoing in vitro fertilization (IVF) or ovulation induction with injectable medications. Less often, ohss occurs during fertility treatments, the use of medications that you take by mouth, such as clomiphene.

The treatment depends on the severity of the condition. The ovarian hyperstimulation syndrome may improve on its own in mild cases, while severe cases may require hospitalization and additional treatment.

Symptoms

The symptoms of ovarian hyperstimulation syndrome often begin within a week after the use of injectable drugs to stimulate ovulation, although sometimes it can take two weeks or more for symptoms to appear. The symptoms may vary from mild to severe and may worsen or improve with time.

The ovarian hyperstimulation syndrome, mild to moderate

With mild to moderate ovarian hyperstimulation syndrome, symptoms can include:

  • Mild to moderate abdominal pain
  • Abdominal distension or increased waist size
  • Nausea
  • Vomiting
  • Diarrhea
  • Pain in the area of the ovaries

Some of the women who used injectable fertility drugs to get a mild form of ovarian hyperstimulation syndrome . This usually disappears after a week. But, if pregnancy occurs, the symptoms of ovarian hyperstimulation syndrome can get worse and last for several days to weeks.

Severe ohss

With severe ovarian hyperstimulation syndrome, which can have:

  • Gain weight fast — more than 2.2 pounds (1 kilogram) in 24 hours
  • Severe abdominal pain
  • Severe, persistent nausea and vomiting
  • Blood clots
  • The decrease of the urine
  • Shortness of breath
  • Tight or enlarged abdomen

When to see a doctor

If you are having fertility treatments and experience symptoms of ovarian hyperstimulation syndrome, tell your health care provider. Even if you have a mild case of ovarian hyperstimulation syndrome , your doctor will want to watch for sudden weight gain or worsening of symptoms.

Contact your doctor immediately if you develop breathing problems or pain in the legs during your fertility treatment. This may indicate an emergency situation that needs immediate medical attention.

Causes

The cause of the ovarian hyperstimulation syndrome has not been well understood. Having a high level of human chorionic gonadotropin (HCG) — a hormone that is normally produced during pregnancy — introduced in your system plays an important role. Ovarian blood vessels react in abnormal form of the hormone human chorionic gonadotropin (HCG) and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts of moving in the abdomen.

During fertility treatments, HCG can be given as a "trigger" for a mature follicle to release the egg. The ovarian hyperstimulation syndrome usually occurs within a week after receiving an injection of HCG. If you become pregnant during a treatment cycle, the ovarian hyperstimulation syndrome can get worse as your body begins to produce its own HCG in response to the pregnancy.

Injectable fertility medications are more likely to cause ovarian hyperstimulation syndrome, which is the treatment with clomiphene, a drug that is administered in the form of pills that are taken by mouth. Sometimes the ovarian hyperstimulation syndrome occurs spontaneously, not related to fertility treatments.

Risk factors

Sometimes, the ovarian hyperstimulation syndrome occurs in women with no risk factors at all. But the factors that are known to increase the risk of ovarian hyperstimulation syndrome include:

  • Polycystic ovary syndrome — a common reproductive disorder that causes irregular menstrual periods, excessive hair growth, and unusual appearance of the ovaries on ultrasound examination
  • Large number of follicles
  • Age under 35 years of age
  • Low body weight
  • High or very higher level of estradiol (estrogen) before the HCG trigger shot
  • Previous episodes of ohss

Complications

Severe ovarian hyperstimulation syndrome is uncommon, but it can be deadly. Complications can include:

  • The collection of fluid in the abdomen, and sometimes the chest
  • Alterations of electrolytes (sodium, potassium, other)
  • Blood clots in large vessels, usually in the legs
  • Kidney failure
  • The torsion of the ovary (ovarian torsion)
  • The rupture of a cyst on an ovary, which can lead to severe bleeding
  • Breathing problems
  • The pregnancy loss of a miscarriage or termination of the cause of complications
  • Rarely, death

Prevention

To reduce your chances of developing the ovarian hyperstimulation syndrome, you will need an individualized plan for their fertility drugs. Expect your health care provider to carefully monitor each cycle of treatment, including frequent ultrasounds to check the development of the follicles, and blood tests to check hormone levels.

Strategies to help prevent ovarian hyperstimulation syndrome include:

  • Adjustment of the medication. Your provider uses the lowest possible dose of gonadotropins to stimulate their ovaries and trigger ovulation.
  • The addition of medication. Some of the drugs appear to reduce the risk of ovarian hyperstimulation syndrome, without affecting the odds of pregnancy. These include low-dose aspirin; dopamine agonists, such as carbergoline or quinogloide; and calcium infusions. Give to women who have polycystic ovary syndrome, the drug metformin (Glumetza) during ovarian stimulation can help prevent the over-stimulation.
  • Cabotage. If your estrogen level is high or you have a large number of follicles developed, your doctor may ask you to leave injectable drugs and wait a couple of days before HCG , which is what triggers ovulation. This is known as cabotage.
  • Avoid the use of anHCGtrigger shot. Due to the ovarian hyperstimulation syndrome often develops after a HCG trigger shot is given, the alternative to HCG for trigger have developed the use of the gonadotropin-releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron), as a way to prevent or limit the ovarian hyperstimulation syndrome .
  • The freezing of embryos. If you are suffering from in vitro fertilization (IVF), all follicles (mature and immature) can be removed from her ovaries to reduce the risk of ovarian hyperstimulation syndrome . Mature follicles are fertilised and frozen, and the ovaries are allowed to rest. You can resume the process of IVF at a later date, when your body is ready.

The ovarian hyperstimulation syndrome

Diagnosis

The ovarian hyperstimulation syndrome diagnosis can be based on:

  • A physical exam. Your doctor will examine you for any weight gain, increased size of the waist and abdominal pain that may be.
  • An ultrasound examination. If you have the ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are larger than normal, with a large fluid-filled cysts, where the follicles developed. During the treatment with fertility drugs, your doctor regularly evaluates their ovaries with a vaginal ultrasound.
  • A blood test. Certain blood tests allow your provider to detect abnormalities in the blood and if your kidney function is impaired because of the ovarian hyperstimulation syndrome .

Treatment

The ovarian hyperstimulation syndrome usually resolves by itself within a week or two or a little more if you're pregnant. The treatment is designed to keep you comfortable, the decrease of the ovarian activity and avoid complications.

The ovarian hyperstimulation syndrome, mild to moderate

The ovarian hyperstimulation syndrome mild usually resolves by itself. Treatment for moderate ohss may involve:

  • Increasing the intake of fluids
  • Frequent physical examinations and ultrasound
  • Daily weight and waist measurements, verification of drastic changes
  • The measurements of the amount of urine produced each day
  • Blood tests to monitor the dehydration, electrolyte imbalance and other problems
  • The drainage of excess abdominal fluid through a needle that is inserted into the abdominal cavity
  • Medicines to prevent blood clots (anticoagulants)

Severe ohss

With severe ohss , you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your healthcare provider may give you a drug called cabergoline decrease your symptoms. Sometimes, your doctor may also give you other medicines, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) — to help suppress ovarian activity.

Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care unit to the liver or lung complications. You may also need blood-thinning medications to reduce the risk of blood clots in the legs.

Self-care

If you develop mild ovarian hyperstimulation syndrome, you will likely be able to continue with their day-to-day routine. Follow the advice of your provider, which may include the following recommendations:

  • Try an over-the-counter pain relievers such as acetaminophen (Tylenol, others) for abdominal discomfort, but to avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had a transfer of embryos, as these medications may interfere with implantation of the embryo.
  • Avoid the sexual relations, because that can be painful and can cause an ovarian cyst to rupture.
  • To maintain a light level of physical activity, avoiding strenuous or high-impact activities.
  • Weigh yourself on the same scale and measure around your abdomen every day, reporting unusual increases to their provider.
  • Call your healthcare provider if signs and symptoms worsen.

Preparing for your appointment

Depending on the severity of the ovarian hyperstimulation syndrome is, your first appointment may be with your primary care provider, with your gynecologist or infertility specialist, or possibly with a medical treatment in the emergency room.

If you have time, it is a good idea to prepare in advance of your appointment.

What you can do

  • Write down any symptoms you are experiencing. Include all the symptoms, even if you don't think that is related.
  • Make a list of all the medications and supplements you take. Write down the dose and how often you take.
  • Have a family member or close friend to accompany you, if possible. You can give a lot of information in your visit, and it can be difficult to remember everything.
  • Take a notebook or notepad with you. The use that is write down important information during your visit.
  • Prepare a list of questions to ask your provider. The list of your most important questions first.

Some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • Does the ovarian hyperstimulation syndrome usually disappear on their own, or will I need treatment?
  • Do you have any printed material or brochures that they can take home with me? What sites do you recommend?

Make sure that you fully understand everything your doctor tells you to. Do not hesitate to ask your provider to repeat information or to ask questions of clarification.

What to expect from your provider

Some possible questions that your doctor may ask include:

  • When did your symptoms begin?
  • How severe are the symptoms?
  • Is there something to improve the symptoms?
  • Does anything seem to make your symptoms worse?
Symptoms and treatment of Ovarian hyperstimulation syndrome