Ovarian Hyperstimulation Syndrome (OHSS) is an exaggerated response to the use of ovulation induction medications, especially during the use of injectable gonadotropin agents. 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.
OHSS is most common in women who are having IVF when serum estradiol levels are high (often >2500 pg/ml). It is most likely to develop when a large number of ovarian follicles (immature eggs) have developed.
OHSS can be classified as mild, moderate or severe, based on symptoms and laboratory findings. One out of three women have some symptoms of mild OHSS when they have controlled ovarian stimulation during IVF cycles. These symptoms include abdominal bloating and nausea and weight gain due to fluid retention (when fluid is not removed from the body tissues). These same symptoms are worse in women with moderate OHSS. Women with severe OHSS usually have vomiting and cannot keep down liquids. They have an increase in discomfort from distention (swelling) of the abdomen (belly). In the worst cases, they can develop shortness of breath. Ovary size is also used as a marker of OHSS. Usually a transvaginal ultrasound can be done to measure ovary size in case of patients with syndrome. Physicians can reduce the risk of OHSS by monitoring of FSH therapy to use this medication judiciously, and by withholding hCG medication.
Treatment of OHSS depends on the severity of the hyperstimulation. Mild OHSS can be treated conservatively with monitoring of abdominal girth, weight, and discomfort on an outpatient basis until either conception or menstruation occurs. Conception can cause mild OHSS to worsen in severity.
Moderate OHSS is treated with bed rest, fluids, and close monitoring of labs such as electrolytes and blood counts. Ultrasound may be used to monitor the size of ovarian follicles. Depending on the situation, a physician may closely monitor a patient's fluid intake and output on an outpatient basis, looking for increased discrepancy in fluid balance (over 1 liter discrepancy is cause for concern). Resolution of the syndrome is measured by decreasing size of the follicular cysts on 2 consecutive ultrasounds. Aspiration of accumulated fluid (ascites) from the abdominal/pleural cavity may be necessary, as well as opioids for the pain. If the OHSS develops within an IVF protocol, it can be prudent to postpone transfer of the pre-embryos since establishment of pregnancy can lengthen the recovery time or contribute to a more severe course. Over time, if carefully monitored, the condition will naturally reverse to normal - so treatment is typically supportive, although patient may need to be treated or hospitalized for pain, paracentesis, and/or intravenous hydration.
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