Ovarian hyperstimulation syndrome (OHSS) is a condition where the ovaries react abnormally to drugs administered for inducing conception. It is characterized by significant ovarian enlargement due to multiple ovarian cysts, and a fluid shift in the tissue space. While most cases of OHSS are mild, severe cases do occur, although they’re rare.
OHSS majorly affects women undergoing fertilization induction treatments and taking hormonal preparatory injections and drugs to promote the growth of eggs in the ovaries.
An excess dose of hormonal remedies or hormone-mimicking drugs can lead to OHSS, in which the ovaries become enlarged and are painful. It is usually mild or moderate, but a few women may have a severe form of this condition, which may lead to excess weight gain, pain in the stomach, vomiting and breathing difficulties.
Spontaneous ovarian hyperstimulation syndrome is not related to fertility treatments and is rare.
The following factors have been linked to an increased prevalence of ovarian hyperstimulation syndrome or OHSS:
Human Chorionic Gonadotropin (hCG) is a hormone normally produced and responsible for fertilization. It is medically supplemented in deficient women, and it is this hormone that may cause OHSS if present in excess amounts. OHSS occurs only after the eggs are released from the ovary (ovulation).
About 3 to 6% of women who undergo IVF develop OHSS after embryo transfer as a complication of treatment.
OHSS usually develops about 10 days after fertility treatments.
Usually, OHSS risk is mild to moderate. But about 1 in 100 women undergoing stimulation of ovaries develop a severe grade of OHSS.
OHSS is based on a combined approach with clinical examination and tests including blood tests and sonography. Abnormal weight gain, increased waist circumference, attributes like abdominal pain, breathing difficulties or urinary complaints may alert your doctor to investigate you for OHSS.
You may need a vaginal ultrasound, which shows enlarged ovaries usually containing fluid-filled cysts. A very high beta hCG level or deranged kidney function tests may hint towards a diagnosis of OHSS.
Mild OHSS usually resolves spontaneously in about a week’s time after diagnosis. You may require an OHSS diet. Eating a high-protein diet is recommended. Please consult your doctor before starting any new diet.
Moderate OHSS requires close monitoring of vital parameters. Adequate fluids prevent dehydration.
Severe OHSS usually necessitates hospitalization and aggressive treatment, including IV fluids, anticoagulants (blood thinners), electrolyte corrections, blood components and intensive care including cardiovascular backup and OHSS radiology management.
There are no scientifically documented home remedies for the treatment of OHSS. It is recommended to refrain from drinking excessive amounts of water or consuming any anti-inflammatory medicines such as aspirin as this can affect your kidneys. Also ensure to keep moving your legs periodically to lower the risk of blood clots.
Certain medical measures help prevent OHSS.
Reducing excessive gonadotropins: Low dose gonadotropin protocols have been publicized to prevent OHSS in high-risk patients with a past history or PCOS. It includes various steps like:
It is advisable to consult your gynecologist as soon as you notice any abnormal symptoms, abdominal or urinary, or a general sense of being unwell.
Conclusion: Since OHSS is usually a side effect or complication of fertility treatment, it should have a high index of suspicion by the treating gynecologist. It may be prevented if diagnosed in the early stages. Consult your doctor if you suspect any symptoms. OHSS can be treated effectively with an integrated approach of a gynecologist, a physician, and an intensivist (critical care physician).