Treating Ovarian Hyperstimulation Syndrome
What is Ovarian Hyperstimulation Syndrome (OHSS)?
Reproductive technology has come such a long way in just the past decade, it’s amazing to think of all the alternatives available now when it comes to building a family. But along with any new advance comes some negative side effects, and relying on fertility medications or in vitro fertilization (IVF) to get pregnant is no exception. The various medications you take to help your ovaries mature more eggs can, in turn, overstimulate them. When the overstimulation causes severe symptoms, the condition is referred to as ovarian hyperstimulation syndrome (OHSS).
The goal of fertility medication is to overcome the body’s mechanism that produces only one egg per cycle. The ovary selects from a group of hundreds of eggs that will ultimately die each month. In natural cycles only one of these eggs matures and ovulates. When fertility medications are administered, many of the eggs that would be lost are rescued and mature. In some cases, the same mechanism that causes several eggs to mature can overstimulate the ovary.
What Causes the Symptoms of OHSS?
The symptoms of OHSS are caused by the fluids and substances released from over-stimulated ovaries. The fluid is shifted from the circulatory system (where it belongs) into the abdomen. The extra fluid results in weight gain and abdominal distension.
The majority of ovarian hyperstimulation syndrome cases are mild and require no treatment except for drinking extra fluids. However, mild OHSS can develop into moderate or severe OHSS.
Typically, OHSS will go away about a week after controlled ovarian hyperstimulation is stopped, but if you are pregnant, the symptoms may last anywhere from 10 to 30 days. This is because human chorionic gonadotropin (hCG) worsens the symptoms of OHSS.
How Have Recent Advances in IVF Impacted OHSS?
Modern IVF stimulation has dramatically reduced the incidence of OHSS. Better success rates occur if the embryo transfer is delayed until the ovary is no longer stimulated. This improved treatment is achieved by highly-efficient freezing of blastocysts. The embryos are thawed in a subsequent cycle when the ovary is no longer enlarged.
Another innovation that has markedly limited the occurrence of OHSS is the decrease in dosage of human chorionic gonadotropin (hCG) used to trigger ovulation. The addition of Lupron surge has achieved similar egg maturity, while markedly diminishing ovarian hyperstimulation.
How are OHSS Symptoms Treated?
Mild OHSS symptoms, such as fluid retention and ovarian discomfort, can be managed by:
- Drinking fluids. Electrolyte-supplemented drinks, such as sports beverages, are suggested. Avoid alcohol and caffeinated beverages. Drink enough fluids so that your urine is pale yellow. Dark urine can mean that you are dehydrated.
- Avoiding strenuous physical activity that could lead to ovarian injury.
- Weighing yourself at the same time every day to monitor for rapid weight gain.
If you gain more than 2 pounds per day, your urinary frequency is decreasing, or you have severe pain, you should contact your fertility doctor.
Dr. Lawrence Grunfeld is a board-certified Reproductive Endocrinologist. He is a clinical associate professor of Obstetrics and Gynecology at the Mount Sinai School of Medicine and co-director of Reproductive Medicine Associates of New York. Dr. Grunfeld received his medical degree at Mount Sinai and his OB/GYN training at the Albert Einstein College of Medicine. He also completed fellowships in reproductive medicine at both the Albert Einstein Medical College and Yale-New Haven Hospital. Dr. Grunfeld served as Director of Fellowship Training at Mount Sinai Medical Center in New York, where he has been performing IVF procedures since 1986.