Women who take injectable hormones (gonadotropins) to stimulate the ovaries during an in vitro fertilization (IVF) cycle are at risk of developing ovarian hyperstimulation syndrome (OHSS). Women undergoing IVF typically administer injectable medication to stimulate the ovaries to produce multiple eggs which are subsequently retrieved surgically. For some women, the ovaries can overrespond and produce hormones which can make the blood vessels leaky. The water content within the blood leaks out of the vessels, causing fluid to accumulate in the abdomen and other places. This can lead to painful symptoms like abdominal swelling and cramping as well as leg swelling and pain. In more severe cases, water can also accumulate in the lungs.
Mild hyperstimulation is somewhat common during an IVF cycle and can cause minor abdominal bloating and discomfort. The symptoms in moderate to severe cases are more pronounced and can include significant pain and swelling in addition to nausea/vomiting, difficulty eating, and shortness of breath. Women with severe OHSS can experience rapid weight gain as a result of extra fluid.
Young women with polycystic ovary syndrome appear to have the highest risk for ovarian hyperstimulation syndrome. Although the condition occurs most commonly with the use of injectable gonadotropins, it can rarely occur with oral fertility medications like Clomid.
Our goal with an IVF cycle is to stimulate the ovaries to get as many eggs as possible while minimizing the risk of OHSS. This is part of the reason IVF patients are monitored so frequently once they start the stimulation medication, so the dose of medication can be adjusted up or down to achieve the maximal effect in a safe manner.
In most cases, mild ovarian hyperstimulation syndrome resolves on its own within a few days.
Moderate OHSS cases may require anti-nausea medication and/or prescription pain medication, along with physical exams and ultrasounds, weight checks, urine measurement, blood work, staying well hydrated, and sometimes draining excess abdominal fluid.
Severe ovarian hyperstimulation syndrome usually includes a hospital stay for monitoring and treatment that includes intravenous fluids, medication to soothe the symptoms, and sometimes a medication to suppress ovarian activity. Patients with severe OHSS might also require a procedure to insert a needle into the abdomen to drain off excess fluid in order to provide some relief of the discomfort.
Women undergoing ovarian stimulation with any signs or symptoms of OHSS should contact their physician immediately for evaluation.
