Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is a potentially serious complication that could occur from fertility treatment especially in vitro fertilization (IVF). About 1 in 3 women develops mild OHSS during their fertility treatment. However, 1 in 5 women develop moderate to severe OHSS.
1. What causes it?
This is due to overstimulation of the ovary by the fertility drugs given.
2. What complications could occur with OHSS?
- Your ovaries develop multiple follicles that may cause your abdomen to become swollen and tender.
- Your blood vessels becomes ‘leaky’ leading to fluid accumulating in the lungs, abdominal cavity and around the heart.
- Could cause damage to your kidneys, liver and lungs.
- Blood clots developing in your legs (deep venous thrombosis) and lungs (Pulmonary embolus).
Unfortunately, we could not fully predict the response of each individual to the fertility drugs. Therefore, the fertility drugs especially gonadotrophin are started using lower dosage then gradually increased accordingly and close monitoring of the follicles developing is done.
3. Who is at risk of developing OHSS?
Some women are at higher risk of developing OHSS:
- Younger women less than 30 years old.
- Women with polycystic ovarian syndrome (PCOS)
- History of previous OHSS with fertility drugs
- Women who gets pregnant following the fertility treatment.
4. How long does OHSS lasts for?
Most of the time the OHSS will last several days. However, if you end up getting pregnant your OHSS may last a bit longer and tend to be worse.
5. How is OHSS categorized?
- Mild
- Moderate
- Severe
This is based on your symptoms, clinical findings and blood investigations.
6. What should I do if I have mild OHSS?
- Drink regularly, but not excessively. Monitor the amount and colour of your urine. You should contact your doctor if your urine becomes reduced or dark colour indicating that you are dehydrated.
- Take paracetamol or panadol if you have pain in your tummy. Avoid aspirin, ponstan or other NSAID (non-steroidal anti inflammatory drugs)
- Do not lie down in bed all day long. Regularly move your legs to prevent blood clots forming in your legs.
- Seek medical treatment if you have severe abdominal pain, difficulty breathing, chest pain or not passing out urine.
7. How is OHSS managed?
This depends on the severity of your OHSS. If it is mild you could stay at home. However, your doctor may admit you to hospital if you have moderate or severe OHSS.
8. What will happen to me in hospital?
- Several investigations will be done (blood test and ultrasound)
- You will be given fluids through a drip.
- Your weight and abdominal girth will be regularly measured
- Pain killers are given usually only paracetamol.
- You may be given injections (i.e heparin) to thinned out your blood and wear supportive leg stockings to prevent blood clots developing in the legs and lungs.
- Rarely you will require invasive procedures to remove excessive fluids from your abdomen (paracentesis) and lungs or abdominal surgery if there is bleeding or twisted ovaries.
- Most of the time you will be in hospital a few days only.
REFERENCES:
Ovarian hyperstimulation syndrome: What you need to know. Royal College of Obstetricians and Gynaecologists Nov 2007.
