Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS) usually occurs as a result of taking hormonal medications that stimulate the development of eggs in a woman's ovaries. These injectable fertility drugs may be prescribed to treat infertility. In ovarian hyperstimulation syndrome, your ovaries become swollen and painful.
About one-fourth of women who take injectible fertility drugs get a mild form of ovarian hyperstimulation syndrome, which goes away after about a week. If you become pregnant after taking one of these fertility drugs, however, your symptoms of ovarian hyperstimulation syndrome may last several weeks. A small proportion of women taking fertility drugs develop a more severe form of ovarian hyperstimulation syndrome, which can cause rapid weight gain, abdominal pain, vomiting and shortness of breath.
In most cases, the symptoms of OHSS begin within 10 days after you take medications to stimulate ovulation. The severity of OHSS symptoms varies, and symptoms may worsen or improve over time.
When to see a doctor
Ovarian hyperstimulation syndrome develops after you take a type of fertility medication that acts directly on your ovaries, stimulating them to produce multiple eggs. This treatment is more likely to cause symptoms of ovarian hyperstimulation than is the more common approach to inducing ovulation — treatment with clomiphene (Clomid, Serophene), a medication that's given as a pill you take by mouth. Your doctor might prescribe oral medication at first before moving on to injectible medications because oral medications are easier to take and they're less expensive.
The hormonal drugs most likely to be involved with developing OHSS are:
OHSS usually happens after the follicle-stimulating phase of a fertility therapy, when you receive an injection of HCG to trigger ovulation. Typically, signs and symptoms appear within the first 10 days after the injection, when the ovarian blood vessels have an abnormal reaction to the hormone and begin to leak fluid. This fluid can swell the ovaries and sometimes moves into the abdomen in large amounts.
Some women may even develop OHSS during a pregnancy achieved following ovulation induction, as pregnancy itself causes a natural increase in HCG levels.
Factors that increase the risk of developing OHSS include:
Young women with polycystic ovary syndrome who have many follicles are at highest risk of ovarian hyperstimulation syndrome. But knowing these risk factors doesn't predict exactly who will get OHSS, and sometimes the syndrome affects women with no risk factors.
About 1 to 2 percent of women undergoing ovarian stimulation develop a severe form of ovarian hyperstimulation syndrome. Complications of severe OHSS may include:
Some of these complications may be life-threatening, but OHSS is unlikely to be fatal. Severe OHSS may increase the chance of pregnancy loss, either through miscarriage or termination because of complications.
Tests and diagnosis
The diagnosis of ovarian hyperstimulation syndrome is based on your symptoms rather than on any test. During treatment with fertility drugs, your doctor will regularly evaluate your ovaries with a vaginal ultrasound exam. This procedure uses sound waves to create an image of the inside of your ovaries. The ovarian follicles show up as dark, circular areas. If you have OHSS, the ultrasound may show that your ovaries are swollen, with large fluid-filled cysts where the follicles developed.
Treatments and drugs
Ovarian hyperstimulation syndrome usually goes away on its own within a week or two, or somewhat longer if you're pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications.
Lifestyle and home remedies
Most women who develop OHSS can continue their day-to-day routine. For mild symptoms, follow these recommendations:
To lessen the chance that you'll develop ovarian hyperstimulation syndrome, your doctor will create an individualized plan for your fertility medications, taking into account any risk factors you have for OHSS. Your doctor will also carefully monitor each treatment cycle with frequent or daily ultrasound exams to view the development of follicles, and with blood tests to check your estradiol level.
Your doctor may use a variety of strategies to help prevent ovarian hyperstimulation syndrome:
Last Updated: 2011-01-15
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