Ovarian hyperstimulation syndrome (OHSS) is a rare, but potentially serious complication of ovarian stimulation that occurs in the second phase of a stimulated cycle (luteal phase) or even, sometimes, in early pregnancy.
How To Diagnose Ovarian Hyperstimulation Syndrome?
For ovarian hyperstimulation syndrome, your physician may present a diagnosis by conducting the following tests:
Physical Examination: Your physician will inspect whether you have an increased waist size and weight gain, along with if you are suffering from any abdominal pain. The diagnosis of ovarian hyperstimulation syndrome is often based on the symptoms and variation in the patient’s weight, and the doctor suspects ovarian hyperstimulation syndrome when the weight gain exceeds 3 kg.
Conducting Specific Blood Tests: Different blood tests enable your physician to monitor for anomalies in your blood as well as give an idea about your kidney functions. Ovarian hyperstimulation syndrome often impairs the normal kidney function.
Ultrasound Analysis: In the case of ovarian hyperstimulation syndrome, analysis of ultrasound often shows whether your ovaries have become larger than normal and the possible presence of large cysts filled with fluid at the site of follicular development. Your physician will continuously monitor your ovaries while treating you with fertility drugs by making vaginal ultrasound analysis.
Impact Of The Disease: Fortunately, ovarian hyperstimulation syndrome is a rare complication of infertility treatment, although its current trend is a slight increase in prevalence.
The rate of moderate ovarian hyperstimulation syndrome is in the order of 3 to 6%, and that of severe ovarian hyperstimulation syndrome from 0.1 to 2%.(4)
What Is The Best Medicine For Ovarian Hyperstimulation Syndrome?
Several medicines may decrease ovarian hyperstimulation syndrome risks without affecting pregnancy chances. These include calcium supplements, dopamine agonists, and low-dose aspirin. Administrating metformin for women with PCOS (polycystic ovary syndrome) while ovarian stimulation often helps to limit hyperstimulation.
Some over-the-counter pain relievers, such as acetaminophen can be used to minimize abdominal discomfort. Do not take ibuprofen compositions or naproxen sodium in case you have undergone a recent embryo transfer because these medicines may interfere with embryo implantation.
Other Treatment Options For Ovarian Hyperstimulation Syndrome
Infusions (installation of water and electrolytes within the system), albumin administration, continuous administration of low-dose dopamine, etc. are some of the treatment procedures.
If pleural effusions cause difficulty breathing, doctors may puncture your chest and drain out the fluid. If stalk torsion occurs, surgery may be performed.
If you are not pregnant, often ovarian hyperstimulation syndrome heals spontaneously, but if you are pregnant, the symptoms will be more severe.(5)
Ovarian hyperstimulation syndrome manifests itself by the presence of ovaries of greatly enlarged size, as well as sometimes significant water retention.(1)
This Syndrome Only Appears If 2 Conditions Are Met:
Stimulation by an ovulation-inducing agent, mainly gonadotropins (anti-estrogens or gonadotropic hormones).
The presence of hCG, either following administration of hCG to trigger ovulation (the OHSS then appears within 3 to 7 days after the triggering), or following production of hCG by the placenta in the event of pregnancy (in this case, the ovarian hyperstimulation syndrome appears within 12 to 17 days after ovulation or induction).
This syndrome can be expressed in varying degrees of severity (minor, moderate or severe form according to WHO) has been the subject of much research in prevention, diagnosis, and treatment. As it involves a potentially fatal complication in IVF, it should not be underestimated. However, with current treatments and preventive monitoring, death due to ovarian hyperstimulation syndrome is rare.(2)
What Are The Clinical Manifestations?
- Symptoms will depend on the degree of severity and generally appear within 3 to 10 days of the outbreak.
- Most often, they disappear spontaneously after a fortnight, but can sometimes extend, especially in case of pregnancy.
- It should be noted that any woman treated for infertility with ovarian inducers who has an excellent response to treatment will very often have clinical manifestations comparable to those of ovarian hyperstimulation syndrome.(2)(3)
What Are The Causes Of Ovarian Hyperstimulation Syndrome?
At present, the exact reasons behind ovarian hyperstimulation syndrome development are not yet well understood and several pathogenic factors have been mentioned.
The fact remains that a very high level of estradiol, as well as the presence of hCG, would cause the activation of factors that would increase the permeability of the smallest blood vessels of the human body (the capillaries). These would then let out part of the liquid they contain in the spaces surrounding the vessels (extra-vascular spaces).
These result in:
- A reduction in the amount of liquid present in the vascular system (hypovolemia).
- The presence of liquids in other spaces (water retention): ascites (liquid in the belly), pleural effusion (liquid around the lungs) in particular.
- There is also a disturbance in the coagulation system, with an increased risk of embolism (blockage).(2)
- Pellicer N, Galliano D, Pellicer A. Ovarian hyperstimulation syndrome. The Ovary: Elsevier; 2019:345-362.
- Dauod L, Schenker JG. Ovarian Hyperstimulation Syndrome (OHSS): Pathogenesis and Prevention. Reproductive Medicine for Clinical Practice: Springer; 2018:83-92.
- Humaidan P, Nelson S, Devroey P, et al. Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Human Reproduction. 2016;31(9):1997-2004.
- Abbara A, Islam R, Clarke S, et al. Clinical parameters of ovarian hyperstimulation syndrome (OHSS) following different hormonal triggers of oocyte maturation in IVF treatment’. 2018.
- Medicine PCotASfR. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility. 2016;106(7):1634-1647.