EXPERT ADVICE: Why do women undergoing fertility treatment get Ovarian Hyperstimulation Syndrome?

You may be at risk of getting swollen ovaries if you are doing IVF, so look out for these symptoms.

If you are undergoing in-vitro fertilisation (IVF) or other fertility treatments, watch out for Ovarian Hyperstimulation Syndrome (OHSS). This condition happens when the hormone injections the woman receives causes her ovaries to swell and become painful.

SmartParents expert and Gleneagles Hospital’s consultant ob-gyn Dr Christopher Chong explains, “The injections cause many follicles [egg sacs] to form ― that is the aim ― and these follicles then secrete more hormones than usual, leading to signs and symptoms of OHSS.”

Usually, these symptoms show up within 10 days of the injection (more details below). Mild OHSS usually resolves in about a week, however, severe OHSS could be life-threatening. In Singapore, Dr Chong reckons that around 6 to 8 per cent of women suffer milder OHSS, while some 1 per cent suffer the severe form of the condition.

“The injections cause many follicles [egg sacs] to form ― that is the aim ― and these follicles then secrete more hormones than usual, leading to signs and symptoms of OHSS.”

While your chances of developing severe OHSS may be slim, it is still a condition to be vigilant to as it can be deadly. Some women may also be more prone to it. Dr Chong has details on OHSS…

What causes Ovarian Hyperstimulation Syndrome (OHSS)?
Ovaries are artificially stimulated for patients on fertility programmes such as IVF or SO-IUI (supraovulation and intra-uterine insemination). Medication is usually given via injections ― rarely by oral medication, except for certain SO-IUI programmes.

The injections cause many follicles to form ― these then secrete more hormones than usual, leading to signs and symptoms of OHSS. The dosages that causes OHSS varies for different patients.

What are the factors that increase your risk of developing OHSS?
* Those with previous OHSS.
* Under 30 years of age (as they have more follicles).
* Those with many follicles.
* Have polycystic ovary syndrome.
* Those with ovarian cysts.
* Women with low bodyweight.
* Have high blood oestradiol (hormone) levels.

 

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What are the most common symptoms of OHSS?

* Distended abdomen.
* Rapid weight gain.
* Abdominal pain.
* Nausea.
* Vomiting.
* Breathlessness or difficulty in breathing.
* Clots forming early, especially in the lower limbs.
* Low urine output.
* The blood vessels become porous and fluid goes from the blood into a third space such as of the abdomen or lungs, causing ascites [accumulation of fluid in the abdominal cavity] and pleural effusion [fluid build-up outside lungs, in pleural area] respectively.

What if the symptoms are mild?
It is always best to visit your gynae as the mild OHSS may progress to severe OHSS. But if the condition is arrested or managed early, the results are good.

“It is always best to visit your gynae as the mild OHSS may progress to severe OHSS. But if the condition is arrested or managed early, the results are good.”

At which point would you know your OHSS is serious?
If unsure, always seek medical advice. Early treatment means easy management and good results.

How do you prevent OHSS?
* Stopping or abandoning the cycle, if possible.
* Delaying embryo transfer [freezing the embryos first, until you are ready to get pregnant]
* Do not give an human chorionic gonadotropin (HCG) [hormone produced during pregnancy] shot/injection.
* Decrease the hormone dosage or changing the medication.
* Stopping injections for certain days. In IVF, injections (with the hormone FSH) are given to stimulate the formation of eggs. The growth of the eggs is monitored by scans, usually every other day. When several of the eggs reach 18mm in size, an injection of the hormone HCG will trigger them to be ready for ovulation. After the trigger, her hormones will rise further, which can then cause OHSS or worsen the condition. Hence, the doctor can delay this trigger (a process called coasting) by stopping the FSH stimulation for a few days if they assess the OHSS risk to have risen or high (such as by measuring the blood oestradiol levels).

How is severe OHSS treated?
In severe OHSS, management is conservative with medical and, at times, ICU support is required to treat the above-mentioned complications. The patient is very closely monitored in the hospital and given fluids and electrolytes. At times, the fluid from her peritoneal (abdomen) or pleural (lung) cavity may even be removed from her body, either via an ultrasound-guided reduction or aspiration.

Photos: iStock

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