What Is The Best Treatment For Ovarian Hyperstimulation Syndrome?

Ovarian hyperstimulation syndrome (OHSS) is a disease in which the ovaries are excessively stimulated by fertility treatment, ovulation inducers, etc. Thus, many follicles develop and ovulate at once, causing various symptoms.

In the case of ovarian hyperstimulation syndrome caused by an ovulation-inducing agent, stopping the administration of the drug during treatment can prevent the disease from becoming more severe.

However, care must be taken when a pregnancy is established, because the stimulation of hCG (human chorionic gonadotropin), which is made by the placental villi that connect the mother and the fetus, can lead to severe illness.(1)

What Is The Best Treatment For Ovarian Hyperstimulation Syndrome?

There are various treatments for ovarian hyperstimulation syndrome depending on the symptoms. The usual treatment procedure is as follows:

Reduction Or Stopping Of Ovulation Inducer: Use of GnRH agonists instead of hCG preparations, or reduce or discontinue the dosage of hCG preparations to prevent the disease from becoming more severe.

Applying Infusion: If you have thrombosis, the doctor may suggest an infusion to make the concentrated blood return to normal.

Administration Of Albumin: If stomach swelling due to ascites or dyspnea through pleural effusion is observed, it is necessary to administer albumin and transfer pleural effusion and ascites into blood vessels. In some cases, a hole may be punctured in the body to drain the accumulated liquid.

Administration Of Low-Dose Dopamine: If urine quantity is not adequate, low dose dopamine is administered continuously to ensure proper urine output and prevent acute renal failure.

Open Or Laparoscopic Surgery: If the ovary has twisted the stem, it is important to perform emergency surgery to cure the twist. Depending on the condition, the ovaries and fallopian tubes may need to be removed.(3)(4)

Future Measures For Ovarian Hyperstimulation Syndrome

For people who frequently suffer from mild or severe ovarian hyperstimulation syndrome symptoms, the treatment of immature ovum by in vitro fertilization (IVM-IVF) may be effective in the future.

This treatment provides little ovarian stimulation from the beginning of the cycle. Then, during the process of follicle growth, eggs are collected and matured outside the body.

The most important thing is to prevent the development of ovarian hyperstimulation syndrome. Previously, the incidence of ovarian hyperstimulation syndrome was surprisingly high at 3.1% (0 severe cases) with clomiphene therapy (oral ovulation induction) and 59.2% with gonadotropin therapy (injection of hMG-hCG). For the gonadotropin therapy, there are 14.4% of severe cases.

These statistics prompted the adoption of various treatments to avoid ovarian hyperstimulation syndrome. For example, it has been reported that the use of pure FSH significantly reduces the incidence of ovarian hyperstimulation syndrome.

Not only careful observation by the ultrasonic diagnosis but also a measurement of blood estradiol, dosage and use of drugs, etc., should be conducted regularly to prevent ovarian hyperstimulation syndrome. New effective means and treatment methods are continuously developing, and physician skills are also improving to manage and predetermine the onset of ovarian hyperstimulation syndrome.(5)

Probability Of Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome occurs in 20 to 30% of cases in which ovulation is induced with hCG preparations. The frequency of severe cases is not so high, with 0.8 to 1.5% per ovulation cycle in people whose symptoms have become worse enough to require hospitalization.

However, it should be understood that infertility treatment using ovulation inducers is one of the side effects that require attention at the onset.(2)

Who Is Prone To Ovarian Hyperstimulation Syndrome?

Women who mainly meet the following conditions are at increased risk for ovarian hyperstimulation syndrome.

  • Under the age of 35 years
  • Thin body frame
  • Has polycystic ovary syndrome (PCOS)
  • Increased dose of hCG preparation
  • Pregnant

Various methods of inducing ovulation are used in infertility treatment, but gonadotropin therapy (hMG-hCG therapy) is particularly effective. But it tends to develop ovarian hyperstimulation syndrome.(2)

Can You Get Pregnant Even With Ovarian Hyperstimulation Syndrome?

If you have ovarian hyperstimulation syndrome, you can still get pregnant. However, there are cases where the disease has become more severe, so it is necessary to consult your doctor and treat ovarian hyperstimulation syndrome at the earliest.

In mild cases, it is advisable to drink plenty of water and avoid intense exercise or sexual intercourse.

If you are using an ovulation inducer for fertilization during in vitro fertilization and you are diagnosed with ovarian hyperstimulation syndrome, you may need to reconsider how to stimulate the ovaries. If the onset is found after egg collection, cancel the embryo transfer and freeze the embryo.(6)

References:

  1. Pellicer N, Galliano D, Pellicer A. Ovarian hyperstimulation syndrome. The Ovary: Elsevier; 2019:345-362.
  2. Peigne M, Lobert M, Tintillier V, Trillot N, Catteau-Jonard S, Dewailly D. Prevalence of ovarian hyperstimulation syndrome (OHSS) and hypercoagulability in patients triggered by GnRH agonist for excessive follicular response: a systematic follow-up. Fertility and Sterility. 2017;108(3):e227.
  3. Medicine PCotASfR. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility. 2016;106(7):1634-1647.
  4. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thrombosis research. 2017;151:S61-S64.
  5. Caretto A, Lanzi R, Piani C, Molgora M, Mortini P, Losa M. Ovarian hyperstimulation syndrome due to follicle-stimulating hormone-secreting pituitary adenomas. Pituitary. 2017;20(5):553-560.
  6. Sangtani A, Ismail M, Khan Z. Timing of Pregnancy After Ovarian Hyperstimulation Syndrome and Pregnancy-Related Outcomes [35T]. Obstetrics & Gynecology. 2019;133:222S.

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