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Ovarian Hyperstimulation Syndrome

OHSS Symptoms, Treatment, and Prevention

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Updated April 09, 2014

Woman with cramps.

Cramps can be a sign of OHSS.

Photo: Tom Le Goff / Getty Images

Being familiar with the symptoms of ovarian hyperstimulation syndrome (OHSS) is key to preventing a severe case. While ovarian hyperstimulation syndrome is typically mild, it can become life threatening. Catching the symptoms early, along with careful monitoring of your treatment cycle by your doctor, can lower the risk of serious complications.

OHSS is a potential side effect of fertility drugs, particularly with gonadotropins taken during an IVF treatment cycle. About 10% of women going through IVF treatment will experience ovarian hyperstimulation syndrome. While OHSS can occur while taking Clomid and other fertility drugs taken orally, it's rare.

What Causes Ovarian Hyperstimulation Syndrome

Some enlargement of the ovaries is normal during fertility drug treatment. With OHSS, though, the ovaries become dangerously enlarged with fluid. This fluid can leak in to the belly and chest area, leading to complications. But the majority of the fluid doesn't come from the follicles themselves. Most of it comes from blood vessels that are "leaky" due to substances released from the ovary.

Ovarian hyperstimulation syndrome can only occur once ovulation takes place. If your doctor suspects that you're at risk, he may cancel your treatment cycle. (Any fertilized embryos from an IVF treatment cycle may be frozen and saved for use during a future cycle.)

Or your doctor may use medications to delay ovulation by a few days. She may prescribe a GnRH antagonist, which will prevent the body's natural LH surge, preventing or delaying ovulation.

Another option may be that your doctor may simply delay administering the hCG trigger shot, a fertility drug that triggers ovulation. Delaying ovulation to lessen the risk of ovarian hyperstimulation syndrome is sometimes referred to as "coasting." This delay of a few days can lower the risk and severity, without seriously decreasing your chances of successful pregnancy.

Symptoms of Ovarian Hyperstimulation Syndrome

As noted above, ovarian hyperstimulation syndrome can only occur after ovulation has taken place. Symptoms may occur a few days after ovulation or IVF egg retrieval or they may not show up for a week or more after ovulation.

Mild symptoms include:

  • Bloating
  • Mild pain or discomfort in the abdomen
  • Mild weight gain
  • Mild nausea
  • Diarrhea

More serious symptoms include:

  • Rapid weight gain, more than 10 pounds in 3 to 5 days.
  • Severe abdominal pain
  • Severe bloating
  • Severe nausea (so much that you can't keep down any food or fluids)
  • Dizziness
  • Trouble with urinating
  • Shortness of breath
  • Rapid heartbeat

If you experience mild symptoms, you should contact your doctor as soon as possible, so he or she can monitor the situation. If you experience any of the serious symptoms, contact your doctor immediately.

Prevention and Treatment of Ovarian Hyperstimulation Syndrome

While you take fertility drugs, your doctor should monitor your body's response to the medications with blood tests and ultrasounds. Rapidly increasing estrogen levels or ultrasounds that show a large number of medium-size follicles, are all possible indicators of ovarian hyperstimulation syndrome risk.

If you develop a mild case of ovarian hyperstimulation syndrome, you probably won't need special treatment.

Here are some things you can do at home to feel better:

  • Take over-the-counter pain relievers, such as Tylenol.
  • Don't overexert yourself; take it easy while you recover.
  • While you shouldn't overexert yourself, you should maintain some light activity. Total bed rest can increase the risk of some complications.
  • Put your feet up. This can help your body get rid of the extra fluid.
  • Sex should be avoided until you feel better. Sexual activity may increase your discomfort, and in the worst case scenarios, may cause ovarian cysts to leak or rupture.
  • Don't drink alcohol (as if you would when you're trying to get pregnant!) or caffeinated drinks, such as coffee, colas or caffeinated energy drinks.
  • Do drink plenty of fluids, around 10 to 12 glasses a day. Drinks with electrolytes, such as Gatorade, are a good choice.

Your doctor will give you instructions on what to watch for and when to contact him. If your symptoms get worse, you should definitely let them know. She may ask you to weigh yourself daily, to monitor weight gain. If you find yourself gaining 2 or more pounds per day, you should call your doctor.

In rare cases, you may need to be hospitalized. Hospitalization may include receiving fluids intravenously (through an IV), and they may remove some of the excess fluids in your belly via a needle. You may also be kept in the hospital for careful monitoring until your symptoms lessen.

Usually, symptoms will decrease and go away once you get your period. If you get pregnant, though, your symptoms may be prolonged, and it may take several weeks to feel completely better. Pregnancy can also make the symptoms worse, so your doctor will want to monitor your situation carefully.

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Sources:

Ovarian hyperstimulation syndrome. Medical Encyclopedia, MedlinePlus. Accessed August 20, 2008. http://www.nlm.nih.gov/medlineplus/ency/article/007294.htm

Ovarian hyperstimulation syndrome. National Guideline Clearinghouse. Accessed August 28, 2008. http://www.guideline.gov/summary/summary.aspx?doc_id=4845

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