How Can I Avoid Ovarian Hyperstimulation Syndrome During IVF & How Is Mild OHSS Treated?

Ovarian hyperstimulation syndrome is the most iatrogenic complication of ovarian multi-follicular induction in IVF. The incidence of severe OHSS varies from 0.5% to 5% and depends on the stimulation protocols in IVF units, the habits in triggering ovulation and the criteria leading to IVF cycle cancellation.

The pathology of Ovarian hyperstimulation syndrome remains unclear however, the HCG seems to be the key player in predisposed patients. HCG used to trigger ovulation, and, in many instances, this leads to excessive secretion of vascular endothelial growth factor which in turn, increases capillary permeability with peritoneal and pleural effusion.

How Can I Avoid Ovarian Hyperstimulation Syndrome During IVF?

How Can I Avoid Ovarian Hyperstimulation Syndrome During IVF

Ovarian hyperstimulation syndrome is the most iatrogenic complication of ovarian multi-follicular induction in IVF. The incidence of severe OHSS varies from 0.5% to 5% and depends on the stimulation protocols in IVF units, the habits in triggering ovulation and the criteria leading to IVF cycle cancellation.

The pathology of Ovarian hyperstimulation syndrome remains unclear however, the HCG seems to be the key player in predisposed patients. HCG used to trigger ovulation, and, in many instances, this leads to excessive secretion of vascular endothelial growth factor which in turn, increases capillary permeability with peritoneal and pleural effusion.

How Can I Avoid Ovarian Hyperstimulation Syndrome During IVF?

Avoiding hyperstimulation syndrome during IVF:

Ovarian hyperstimulation syndrome (OHSS) can be a severe and potentially life-threatening complication of gonadotrophin stimulation for IVF. In addition to the medical consequences, there is a significant economic burden associated with this condition, therefore it has to be prevented to avoid absence from work, bed rest or hospitalization requirements.

ART outcome is one of the best preventive procedures for Ovarian hyperstimulation syndrome to preclude the development of a disease and to decrease the risk. To lessen the risk of severe difficulties, secondary preventative processes are typically applied. Lowering the dose of gonadotropins is regarded as the typical option to keep their estrogen levels in a lower range.1,2

Prevention of Ovarian hyperstimulation syndrome is a multi-stage process. The key to the main avoidance of OHSS during COS is identifying risk factors and modifying the ovarian stimulation protocol suitably using approaches. Clinical study shows there is another strategy used to prevent the condition, this is by changing the type of trigger because HCG is the primary factor in stimulating VEGF, therefore by using an agonist trigger, there is an increase in LH from the patients’ pituitary that causes egg maturation. This procedure is extremely beneficial because patients do not develop OHSS, but does have some equal downsides

This technique can be applied only in the GnRH antagonist protocol

It cannot be used in patients who have a form of amenorrhea called hypothalamic amenorrhea in which menstruation stops for several months due to a problem involving the hypothalamus because it requires a pituitary that is responsive to the medication.

Changing the type of trigger can often cause a blockage in the uterine lining that frequently mediates with embryo implantation.3,4

How Is Mild Ovarian Hyperstimulation Syndrome Treated?

Ovarian hyperstimulation disorder commonly resolves on its own in a week or two or a bit extensive if you’re in the prenatal phase. Treatment is intended at keeping you relaxed, reducing ovarian movement and preventing complications.

Mild Ovarian hyperstimulation syndrome can be managed by:

Improving Fluid Intake- Fluid intake is very crucial in improving the condition. Patients associated with severe Ovarian hyperstimulation syndrome will require fluids for initial hydration. Meticulous observing of fluid intake and urine output is crucial until symptoms improve or diuresis commences. Later, fluids should be directed carefully, in the volumes required to sustain ample urine output (>22–28 mL/h) and reversal of hemoconcentration (a decrease in plasma volume).

Strenuous Physical Activity Should Be Avoided- Strenuous exercise and sexual activity should be avoided until symptoms are resolved. When these activities are performed, the risk of ovarian torsion increases when the ovaries are substantially inflated and to avoid injuries to the ovaries.

Most patients with mild Ovarian hyperstimulation syndrome can be handled on an outpatient basis with recurrent observation in hospitals or clinics. The patient should be counseled to determine her weight and stomach girth daily, drink electrolyte supplemented fluids, circumvent active physical movement and report any waning of symptoms instantly.5,6

References:

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