Ovarian Hyperstimulation Syndrome (OHSS)
Why would you be dealing with Ovarian Hyperstimulation Syndrome (OHSS)?
Because you have undergone controlled ovarian hyperstimulation – either for IVF or IUI. Every time you undergo controlled ovarian hyperstimulation there is a small degree of risk. However, your symptoms are likely to be very mild, involving only a minor degree of swelling or discomfort. OHSS usually starts a couple of days after an egg retrieval – although, like everything, this can vary and your symptoms may start earlier or later.
Factors Which Increase Your Risk
1. Lots of follicles and high estrogen levels. This is the biggest risk factor, and one of the reasons why more isn’t necessarily better. You may be “coasted” to reduce the number of follicles/estrogen levels.
2. hCG seems to trigger, prolong, and increase the severity of OHSS. If you are at very high risk, your retrieval may be cancelled because the hCG trigger injection will be deemed too dangerous. If you are at slightly lower risk, you will be asked to trigger and undergo retrieval, but your transfer will be cancelled to avoid pregnancy in that cycle and the embryos frozen for later use.
3. Low body mass index. For some reason skinny women are slightly more at risk. No-one knows why.
What You Can Expect
Symptoms: Pain or swelling of the belly. Decreased urine output and pain when urinating. Nausea and vomiting. Thirst. Shortness of breath. Sudden increases in weight.
The average case lasts seven to ten days. Unfortunately, there is no way to make the OHSS go away. Instead, you need to support your body until the hormones settle down. Most of the time, adequate monitoring and treatment can be given at home – this is discussed in more detail under “troubleshooting”. If your symptoms become too severe for at-home treatment, you will be admitted to the hospital. Although the principles of supportive care and monitoring remain the same, both will be more aggressive for in-hospital patients.
1. Keep up the fluids. You will be losing fluids into your abdominal cavity. If you can’t keep up with this loss by drinking fluids, you will be put on an IV drip.
2. Keep up the proteins. You will also be losing proteins into your abdominal cavity. If eating protein-rich foods and drinking protein shakes isn’t enough, you can be given albumin via a drip. 3. Control pain. The type of painkiller you need will depend on your level of pain.
4. Control nausea. Anti-nausea medications may be used.
5. Control shortness of breath. Mild shortness of breath can be treated with rest. In more severe cases, intranasal oxygen may be used.
6. Maintain organ function and treat specific complications. If the pressure in your abdomen is too great, an in-dwelling tube can be placed under local anaesthetic to drain some of the fluid away. As the proteins in this fluid are lost to the body forever, and cannot be resorbed, this will only be done if the benefits are thought to outweigh the risks. If you are having trouble emptying your bladder due to the enormous swelling of your ovaries, you may need an in-dwelling urinary catheter placed. Other specific complications are treated as they arise.
7. Maintain circulation. You may find that fluid collects around your lower body. Flight socks can be used to prevent swelling around the calves. Heparin injections and aspirin may be prescribed to lower the risk of clotting and thromboembolism.
1. Daily weight checks.
2. Measurement of urine output and fluid intake.
3. Daily blood tests for in-hospital patients.
4. Monitoring vital signs for in-hospital patients (heart rate, respiratory rate, oxygenation, temperature).
5. X-rays and ultrasounds may be used for some in-hospital patients, depending on symptoms.
Most clinics advise taking a cycle off to allow your reproductive system to get back to normal. Opinions do vary, though – some specialists are willing to do an FET the very next cycle, and others advise a longer wait of several cycles. Most patients find their next cycle is longer than usual. It’s common to be anything from two to four weeks late in the cycle following OHSS. The cycle after that may also be prolonged.
Ways to Troubleshoot
You should report any and all symptoms to your specialist. This is important! Simple treatment for mild cases: 1. Drink plenty of fluids. Electrolye drinks (sports drinks) and protein shakes (eg sustagen) are especially good. This is because your body is losing fluid, electrolytes and proteins into your abdominal cavity. High-protein foods, such as chicken, are also recommended. 2. Take pain killers. Doctors usually prescribe paracetamol/acetominophen plus or minus codeine for mild pain. If these don’t work, consult your specialist. 3. Rest up. I promise this will make you feel better. 4. Monitor your symptoms. Check your weight on the bathroom scales each morning. Report any sudden increases in weight. Measure your waistline. If you are putting on inches each day, talk to your clinic. Take note of your urine volume. If it’s decreasing, or if you find you are going to the toilet very frequently without passing much each time, contact your clinic. If any other symptoms arise – nausea, vomiting, shortness of breath etc – contact your clinic.
1. Don’t be afraid to talk to your clinic about your symptoms. If your symptoms are changing and progressing – talk to them again. Better safe than sorry.
2. OHSS is tough mentally and emotionally. There are an awful lot of hormones involved, and you are genuinely sick, which is frightening. The fact no-one can tell you how long it will last is frustrating – will it be a few days or will you be that rare patient whose symptoms go on for over a month? Supportive treatments, especially IV albumin, can make you feel better temporarily and lead you to think it’s all over – until they wear off. This is very different from illnessess or injuries you may have had in the past, where each day you can feel yourself getting a little bit better. With OHSS, you may be getting worse each day, or feeling up and then down again, with no clear ending in sight. Please remember almost everyone gets better in seven to ten days. During my ten days in the hospital, a couple of things were said to me which I clung to. A nurse said, “You will get through this – hour by hour, day by day, moment by moment.” And another said, “You’ll never stop putting yourself through these things for your kids.”