Ovarian Hyperstimulation Syndrome (OHSS)

One of the most uncomfortable side effects women experience from fertility medications is known as ovarian hyperstimulation syndrome. Although it can be very uncomfortable, it usually resolves relatively quickly. It usually lasts a few days but in severe cases can last up to several weeks.

Symptoms of ovarian hyperstimulation syndrome

Symptoms are: weight gain; decreased urination; a feeling of pelvic fullness and mild cramping; and difficulty getting comfortable, especially at night. Often these symptoms go away after the egg retrieval and reappear a few days before a positive pregnancy test. The symptoms are caused by ovarian enlargement and the collection of fluid in the pelvis coming from the ovaries.

If you experience symptoms of hyperstimulation we encourage you to:

• Get fluids into your circulation (any fluid is good, but especially low carbohydrate athletic recovery drinks with some amount of sodium and potassium). Try to drink 64-96 oz. every 24 hours.
• Take 2 Extra Strength Tylenol every 8 hours or use your narcotics from your egg retrieval if you are in pain.
• Walk and move around every 2 hours while awake.
• Eat foods that are high in protein.

If you think you may be experiencing OHSS, please call the office during business hours or come to the office at 8:30 the following morning (no appt. is necessary). We will evaluate you with ultrasound and may perform blood work and/or a paracentesis. A paracentesis involves placing a needle through your vagina and into the fluid in your pelvis to remove it. The effects are almost immediate. This procedure can be repeated if the need arises and will not lessen the chances of a healthy pregnancy.

Of interest, is that women with OHSS often have lower HCG pregnancy levels than expected. So if your levels of HCG are not climbing according to what is to be expected, this is often the effect of the OHSS on your blood volume.

Who is at risk for OHSS?

Who is predisposed to OHSS? Women who have more than 20 eggs retrieved, along with high estrogen values (>3000 pg/mL) are at risk. Women with polycystic ovarian syndrome and those with a high AMH are at risk because they tend to produce many eggs.

How can we reduce the risk? Since we monitor your progress throughout your cycle, we can adjust your medication dose as needed in order to try to minimize your risk of experiencing OHSS. Drs Meyer, Couchman and Park and the nurses will usually let you know if you are at risk for OHSS. If you are doing IVF we may ask you to take only one Ovidrel injection instead of two on the trigger day, or use a decreased dose of hCG instead of 10,000 IU. Some patients are candidates for using a medication called lupron instead of Ovidrel, along with a small amount of hCG. We may also recommend a medication, cabergoline, to decrease your risk for OHSS.