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How Many Follicles Cause Ovarian Hyperstimulation Syndrome & What Does OHSS Mean In Pregnancy?

Ovarian hyperstimulation syndrome is a clinical disorder that can occur as a consequence of fertility treatment and IVF. The symptoms are often mild but can seldom be severe and even life-threatening. The cause of ovarian hyperstimulation syndrome is not fully understood. Prostaglandin and keto prostaglandin may be involved.

Increased permeability within the ovarian follicular wall is thought to be mediated by prostacyclin with subsequent development of ovarian cysts and accumulation of fluid in the extravascular, extracellular space and enlargement of ovaries. Mild and moderate cases of Ovarian hyperstimulation syndrome doesn’t require special treatment other than rest at home and mild analgesic or antiemetic therapy or replacement of body fluid losses by intake of small amounts of electrolyte-rich fluids throughout the day.1

How Many Follicles Cause Ovarian Hyperstimulation Syndrome?

How Many Follicles Cause Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome may arise after stimulation of the ovaries through drug -induce to produce multiple eggs such as human chorionic gonadotrophin (hCG) and human menopausal gonadotrophin. It is uncommon with clomiphene except for polycystic ovarian syndrome (PCOS).

The ovaries may produce 20 follicles or higher and enlarge subsequently to an upsurge in serum concentrations of hCG. OHSS is a systemic disorder. Vasoactive mediators (involved in the pathogenesis of various types of angioedema) are discharged from the hyperstimulated ovaries, causing an upsurge in capillary permeability. This eventually causes the capillaries to become leakier allowing cells and fluid to leave and enter the surrounding tissue.

Most fertility hospitals would probably look for 4 mature follicles before initiating hormone to release an egg during the menstrual cycle for In Vitro Fertilization. However, this is not well understood; studies states that only fewer follicle produces high-quality eggs and this is enough for pregnancy. Too many follicles often result in Ovarian Hyperstimulation Syndrome (OHSS). It is possible the unrestrained stimulus of follicles during the first trimester of gestation by hCG ends in extreme follicular conscription detected in this condition.2,3

What Does Ovarian Hyperstimulation Syndrome Mean In Pregnancy?

Ovarian hyperstimulation syndrome (OHSS) is a widespread side-effect of fertility medications, especially those employed during in-vitro fertilization. OHSS occurs when your ovaries over-respond to the medications and produce too many egg follicles. This syndrome typically begins shortly after the egg collection however in rare cases, it can even occur at a later stage.

Several instances of Ovarian hyperstimulation syndrome show minor symptoms and disappear after a few days of treatment either at home or the fertility clinic. The typical symptoms of Ovarian hyperstimulation syndrome involve the enlarged or swollen abdomen, mild to moderate pain in your lower abdomen and nausea sensation.

However, in some cases, the condition becomes intense and the patient would require staying in the hospital until they recover. The condition left untreated often leads to life-threatening conditions such as accumulation of fluids to your body system, ovary enlargement and kidney complications. If symptoms are present, a transvaginal or abdominal ultrasound will be recommended by your doctor to determine ovary size and to measure the amount of fluid collected.

These complications may typically be avoided by identifying the signs, symptoms, and clinical theories that OHSS is getting worse and getting appropriate treatment. Women with symptoms of OHSS should seek medical attention to a gynecologist acquainted with assisted reproduction as soon as they have symptoms.

Earlier researches hypothesized that Ovarian hyperstimulation syndrome may have a potential negative impact on the quality of the oocytes. If this is the case, it may have damaging consequences on the quality of the embryos and the developing gestation at its premature phases and therefore may cause pregnancy loss.4,5


  1. Prediction of Ovarian Hyperstimulation Syndrome in Patients Treated with Corifollitropin alfa or rFSH in a GnRH Antagonist Protocol https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780699/
  2. Ovarian Hyperstimulation Syndrome. OHSS information | Patient https://patient.info/doctor/ovarian-hyperstimulation-syndrome
  3. Ovarian Hyperstimulation Syndrome https://emedicine.medscape.com/article/1343572-overview
  4. What are the symptoms of ovarian hyperstimulation syndrome (OHSS)? https://www.babycentre.co.uk/x1014381/what-are-the-symptoms-of-ovarian-hyperstimulation-syndrome-ohss
  5. Ovarian Hyperstimulation Syndrome (OHSS) – ReproductiveFacts.org https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-hyperstimulation-syndrome-ohss/

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 13, 2020

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