Ovarian overstimulation syndrome or OHSS is one of the main complications of in vitro fertility. It is an overreaction of drugs that promote ovulation. It has multiple follicular developments, ovarian enlargement, and capillary permeability in both ovaries. These medications sometimes cause excessive stimulation of the ovaries, causing them to swell and then leak fluid in the abdomen and chest. Some symptoms include weight gain, a swollen abdomen, and shortness of breath. As a rule, the symptoms are mild and the patient heals quickly, which makes the prognosis excellent. However, life-threatening complications occur in some cases.(1)
What Is The Prognosis For Ovarian Hyperstimulation Syndrome?
The prognosis of ovarian hyperstimulation syndrome is mostly great and the disease gets healed itself in the majority of cases. The mild and moderate forms of the disease can be easily dealt with and the patient does not need hospitalization. In severe cases, intensive care in hospital settings may be required. The disease has a low mortality rate with one in 450-500 thousand women. The prompt onset of treatment after early diagnosis can prevent the disease from becoming severe. It is, therefore, important to consult your doctor immediately if you are experiencing the following symptoms while receiving ovarian stimulation therapy.
If the procedure does not lead to pregnancy then the ovarian hyperstimulation syndrome signs generally get resolved within 7 to 10 days. But it may become worse in case you become pregnant during the period. In such a scenario, the symptoms also last longer.(3)
Lifestyle Changes For Ovarian Hyperstimulation Syndrome
If you have mild ovarian hyperstimulation syndrome, you may be able to continue your daily work without much problem. Some of the helpful lifestyle changes are:
- Do not conduct sexual intercourse during this period as this can be painful and it may result in the rupturing of ovarian cysts.
- Maintain a low level of physical activity and avoid high intensity or strenuous actions.
- Monitor your body weight using the same scale and measure the circumference of your abdomen regularly. Report your doctor if you find any abnormal increase in weight or abdominal circumference.
- If your symptoms and signs worsen, call your doctor immediately.(5)
The frequency of ovarian hyperstimulation syndrome varies from 0.5 to 14% with different patterns of ovulation stimulation and the incidences are rising in the current era. The disease has varying degrees of severity and can lead to death in rare cases when the development of thromboembolic complications or ARDS takes place. The death rate is low. Severe forms of the syndrome that require hospitalization in the intensive care unit are noticed in 0.2-10% cases.(2)
Symptoms Of Ovarian Hyperstimulation Syndrome
The severity of the syndrome is directly related to the severity of the hemodynamic disorders that determine the clinical picture. The onset of the syndrome can be gradual with a progressive increase, and sudden (acute) manifestation of body fluid redistribution in different parts (accumulation of fluid forming cavities).
The common symptoms include abdominal pain often without clear localization, diarrhea, dizziness, dry cough (worse when lying down), dry mouth, feeling tension, fever, flatulence, headache, nausea, rare urination, shortness of breath at rest and when under stress, swelling of the vulva and lower limbs, vomiting, and general weakness.(4)
Causes Of Ovarian Hyperstimulation Syndrome
The immediate cause of ovarian hyperstimulation syndrome is the body reaction to hormone preparations affecting ovulation. Generally, such agents are used for in vitro fertilization or egg donation procedure, in the treatment of infertility and anovulatory cycles. The hormone therapy often makes the ovaries to produce an excessive amount of steroid hormones (progesterone and estrogen). A high concentration of hormones leads to systemic damage to the endothelium and an increase in the permeability of the vessel wall. Against the background of a general release of protein-rich liquid outside the vessels, liquid collects in the cavities of the body and the interstitium.(2)
Risk Factors For Ovarian Hyperstimulation Syndrome Development
The following women are more at risk of developing ovarian hyperstimulation syndrome:
- Age less than 35 years
- At the beginning of pregnancy
- Have allergic diseases
- Maturation of more than ten follicles in the ovulation stimulation protocol
- Slim body frame
- Support the luteal phase with drugs HG
- The presence of polycystic or multi follicular ovaries
Use of gonadotropin-releasing hormone agonists and high doses of gonadotropins.(2)(5)
- 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.
- 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.
- 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.
- Medicine PCotASfR. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and sterility. 2016;106(7):1634-1647.
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