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What Are The First Symptoms Of Ovarian Hyperstimulation Syndrome?

OHSS or ovarian hyperstimulation syndrome is a kind of ovarian swelling caused by excessive stimulation of the eggs (follicles) in the ovaries. This usually occurs as a side effect of the ovulation inducers prescribed during fertility treatment. In this condition, the water present in the blood leaks out of the blood vessels and collects in the stomach and chest known as ascites and pleural effusion respectively.

Moreover, it makes the concentrated and blood becomes highly viscous. When it becomes severe, thrombus may form and renal function may be impaired. The ovaries themselves, usually about 3 to 4 cm in size, may swell more than 12 mm in severe cases. Death may occur in severe conditions but is usually rare. Ovarian hyperstimulation syndrome and ascites are common immediately after ovulation and in early pregnancy.(1)

What Are The First Symptoms Of Ovarian Hyperstimulation Syndrome?

The Symptoms Of Ovarian Hyperstimulation Syndrome – What Is Ascites?

If the following symptoms appear after using an ovulation inducer for infertility treatment, ovarian hyperstimulation syndrome may be present. See your doctor right away if you notice the following symptoms.(2)

Lower Abdominal Tension, Nausea, Vomiting Are Common Symptoms

As the ovaries swell, the water in the blood gets collected in the stomach, called “ascites“. This can lead to a feeling of uneasiness, like a stretched lower abdomen, or bloating, as well as nausea and vomiting.

Are There Any Subjective Symptoms? Possibility Of Hidden Diseases

  • Sudden Weight Gain: In some cases, ascites accumulates and increases weight. Be careful when you suddenly gain weight, even though your diet hasn’t changed much.
  • Dyspnea: In rare cases, pleural effusions, in which water gets collected in your chest, can make breathing difficult.
  • Symptoms Similar To Dehydration: Reduced kidney blood flow can cause dehydration. If you feel thirsty, have less urine, or feel like your body is low on water, it may be a symptom, so tell your doctor.
  • Sudden Belly Pain: In one of the most severe cases, the swollen ovaries are twisted by ascites to make them more mobile, causing acute abdomen pain.

What causes ovarian pain? Does the right and left lower abdomen tingle? Is it different before and after menstruation? – These are critical things to consider and convey everything to your physician.

Thrombosis Or Cerebral Infarction

Thrombosis is one of the most serious cases that occur due to the thickening of the blood (blood becoming concentrated because of water loss) or abnormal blood coagulation caused by ovarian hyperstimulation syndrome.(3)

Can Ovarian Hyperstimulation Syndrome Be Prevented?

Hospital Consultation Diagnosis

When performing infertility treatment, your medical team will try to prevent ovarian hyperstimulation syndrome from developing or becoming severe. For example, in gonadotropin therapy, treatment is performed keeping the dose of an ovulation inducer as small as possible while observing follicle growth.

If many follicles start growing, one option is to stop using the inducer and let it grow naturally. Conventionally, if there are four or more follicles of 16 mm or longer during ovulation induction, the administration of hCG preparations is stopped as there is the chance of ovarian hyperstimulation syndrome as well as multiple pregnancies.

Beware Of Subjective Symptoms Of Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome is a disease that can be accompanied by dangerous complications when it gets worse. However, if you notice the symptoms early and treat them immediately, you can minimize the risk of severity and other complications.

During fertility treatment, you should be aware of your physical condition and consult your doctor if you feel that something is wrong with using an ovulation inducer. Consult your doctor immediately if you feel abdominal pain or pain in the uterus.(4)(5)

Risk Factors For Ovarian Hyperstimulation Syndrome

You are more prone to ovarian hyperstimulation syndrome if you fall in the following categories:

  • A PCOS (polycystic ovary syndrome) patient
  • At the time of pregnancy (because a large amount of hCG is secreted)
  • Blood estradiol (E2) is more than 3000 pg/ml
  • Conducted superovulation stimulation for intractable infertility
  • GnRH is used in combination with ovarian hyperstimulation for in vitro fertilization (IVF-ET)
  • hCG is used to supplement luteal function
  • Low body weight and small physical built
  • Many small follicles exist around the ovarian cortex (necklace sign)(5)


  1. Pellicer N, Galliano D, Pellicer A. Ovarian hyperstimulation syndrome. The Ovary: Elsevier; 2019:345-362.
  2. Mai Q, Hu X, Yang G, et al. Effect of letrozole on moderate and severe early-onset ovarian hyperstimulation syndrome in high-risk women: a prospective randomized trial.
  3. American journal of obstetrics and gynecology. 2017;216(1):42. e41-42. e10.
  4. Sopa N, Larsen EC, Andersen AN. A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF. Case reports in obstetrics and gynecology. 2017;2017.
  5. Medicine PCotASfR. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility. 2016;106(7):1634-1647.
  6. Dauod L, Schenker JG. Ovarian Hyperstimulation Syndrome (OHSS): Pathogenesis and Prevention. Reproductive Medicine for Clinical Practice: Springer; 2018:83-92.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 15, 2020

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