Ovarian Hyperstimulation Syndrome : Causes-Symptoms-Diagnosis-Treatment

 What Is Ovarian Hyperstimulation Syndrome(OHSS)?

Ovarian hyperstimulation syndrome (OHSS) is a trouble of fertility remedy,

in particular In vitro fertilization (IVF). It can be probably extreme and it's miles vital that

you are aware about it in case you are having any fertility remedy. Approximately a third of

patients can have moderate signs and symptoms, with simplest 2-8% of sufferers wanting scientific intervention.

OHSS develops if, for the duration of your treatment while you're having injections, your ovaries

develop too many follicles (the sac which incorporates the egg) as they over-respond to the

medicine. If this happens, fluid from the blood vessels may additionally leak into your abdomen and

in a few cases into the space around the heart and lungs. The kidneys and liver may additionally

be affected, but this is normally mild and will settle without medical intervention.

Most cases of OHSS arise in ladies undergoing fertility treatment, however this circumstance can

broaden in girls receiving any fertility remedy wherein the ovaries are inspired with

injections or in remedy where capsules are given to stimulate ovaries, consisting of clomid. 

What Is Ovarian Hyperstimulation Syndrome(OHSS)?
Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) takes place when a woman’s ovaries swell and leak fluid into the body. This circumstance is a trouble which can occur in girls who get hold of fertility treatments that stimulate the ovaries to produce extra eggs than typical, but there are rare instances of OHSS taking place spontaneously.

In the past, OHSS was an enormously commonplace hardship of in vitro fertilization (IVF). New protocols and techniques have made this condition rare, besides for mild instances.

OHSS is more commonplace in ladies receiving fertility treatments who've polycystic ovarian syndrome (PCOS). PCOS is a reproductive disorder concerning a hormonal imbalance.

Most instances of OHSS are mild and cause temporary discomfort. Severe cases of the situation are rare but may be life-threatening.

  1. Female Reproductive System

  • Internal reproductive organs

  1. Ovaries

  2. Fallopian tubes

  3. Uterus

  4. Cervix

  5. Placenta

  • External reproductive organs

  1. Vulva

  2. Clitoris

  3. Vagina

Medical terms

  • Ovarian hyperstimulation syndrome is an exaggerated response to extra hormones. It normally occurs in women taking injectable hormone medicines to stimulate the improvement of eggs within the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and grow to be painful.
  • OHSS might also occur in girls undergoing in vitro fertilization (IVF) or ovulation induction with injectable medicinal drugs. Less regularly, OHSS happens for the duration of fertility remedies using medications you're taking by using your mouth, including clomiphene.
  • Treatment relies upon the severity of the condition. OHSS can also improve on its own in slight cases, even as intense cases might also require hospitalization and additional treatment.
  • Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology.
  • The syndrome is characterized with the aid of cystic expansion of the ovaries and a fluid shift from the intravascular to the 1/3 area due to increased capillary permeability and ovarian angiogenesis. Its incidence is dependent on the management of human chorionic gonadotropin (hCG). β-hCG and its analogs, estrogen, estradiol, prolactin, histamine and prostaglandins have all been implicated in OHSS but now it's miles an increasing number of higher understood that the vasoactive substances including interleukins, tumor necrosis component-α, endothelin-1, and vascular endothelial boom thing (VEGF) secreted by using the ovaries have been implicated in growing vascular permeability. Enlargement of the ovaries causes stomach pain, nausea and vomiting. Leakage of fluid from follicles, accelerated capillary permeability mainly to 1/3 spacing (because of the release of vasoactive substances), or frank rupture of follicles can all motivate ascites. Due to leakage of fluid via the impaired blood vessels both inside and out of doors the ovary there is big fluid-shift from the intra-vascular bed to the 0.33 compartment outcomes in intravascular hypovolemia with concomitant improvement of edema, ascites, hydrothorax and/or hydropericardium. Low-dose gonadotropin protocols have been implemented to lessen the dangers of fertility remedy in polycystic ovary syndrome patients. Prophylactic albumin management may additionally interrupt the development of OHSS via increasing the plasma oncotic stress and binding mediators of ovarian beginning. OHSS is significantly lower in an antagonist protocol than in an agonist protocol. Cabergoline inhibits partially the VEGF receptor 2 phosphorylation tiers and related vascular permeability without affecting luteal angiogenesis reduces the ‘early’ (in the first nine days after hCG) onset of OHSS. To save you from thrombosis, subcutaneous heparin 5000-7500 U/d begins on the first day of admission. These sufferers need a clinic ward wherein the scientific image is well understood and the personnel have know-how in its treatment and comply with-up. Admission to an intensive care unit is important while vital OHSS develops.

Ovarian hyperstimulation syndrome (OHSS) occurs in women undergoing IVF treatment It is a complication of the fertility stimulation process and occurs when the ovaries are stimulated to produce several mature eggs during IVF treatment whereas one or two is more usual OHSS can be mild or severe but it can lead to abdominal pain and distension OHSS can be life-threatening if fluid accumulates very quickly in the abdomen and in other parts of the body The most common symptoms of OHSS are: Abdominal pain and distension Fatigue and malaise Nausea vomiting and diarrhea (sometimes these symptoms occur without distension).

Symptoms Ovarian hyperstimulation syndrome(OHSS)

The swollen and leaking ovaries because of OHSS can cause several signs. The kinds of signs and symptoms decide the severity of your OHSS.Symptoms of ovarian hyperstimulation syndrome frequently begin inside a week after the usage of injectable medications to stimulate ovulation, although every now and then it is able to take  weeks or longer for signs to seem. Symptoms can variety from moderate to severe and might worsen or improve over time.

Mild to moderate OHSS

With mild to mild ovarian hyperstimulation syndrome, signs can include:

  • Mild to moderate abdominal pain

  • Abdominal bloating or increased waist size

  • Nausea

  • Vomiting

  • Diarrhea

  • Tenderness in the area of your ovaries

Some ladies who use injectable fertility tablets get a moderate form of OHSS. This typically goes away after about a week. But, if pregnancy takes place, signs and symptoms of OHSS may also get worse and ultimately several days to weeks.

Severe OHSS

With extreme ovarian hyperstimulation syndrome, you might have:

  • Rapid weight gain — more than 2.2 pounds (1 kilogram) in 24 hours

  • Severe abdominal pain

  • Severe, persistent nausea and vomiting

  • Blood clots

  • Decreased urination

  • Shortness of breath

  • Tight or enlarged abdomen

When to see a doctor

If you are having fertility remedies and you experience signs and symptoms of ovarian hyperstimulation syndrome, tell your health care company. Even when you have a slight case of OHSS, your company will want to look at you for sudden weight advantage or worsening signs.

Contact your company right away in case you expand respiratory problems or ache on your legs at some stage in your fertility treatment. This may indicate a pressing scenario that needs prompt medical attention.

Causes Ovarian hyperstimulation syndrome(OHSS)

OHSS is as a result of a pregnancy hormone referred to as human chorionic gonadotropin (HCG). HCG is created by way of the cells that form the placenta around a developing embryo and can be detected as early as one week after your egg is fertilized. 

OHSS takes place when you have higher ranges of HCG. High degrees rarely occur clearly. Fertility treatments, mainly people who contain injections of HCG, can overstimulate your ovaries. When HCG is delivered for your machine, your ovaries can also react abnormally by swelling and leaking fluid, mainly to OHSS.

The reason for ovarian hyperstimulation syndrome is not fully understood. Having an excessive stage of human chorionic gonadotropin (HCG) — a hormone normally produced in the course of being pregnant — introduced into your gadget plays a function. Ovarian blood vessels react abnormally to HCG and start to leak fluid. This fluid swells the ovaries, and every now and then big amounts pass into the stomach.

During fertility remedies, HCG can be given as a "trigger" so that a mature follicle will release its egg. OHSS commonly takes place within every week after you acquire an HCG injection. If you come to be pregnant for the duration of a treatment cycle, OHSS can also worsen as your body begins generating its very own HCG in reaction to the pregnancy.

Injectable fertility medicines are more likely to motivate OHSS than a remedy with clomiphene, a remedy given as a tablet you're taking via mouth. Occasionally OHSS occurs spontaneously, no longer associated with fertility treatments.


  • Swelling.

  • Pain.

  • Nausea.

  • Vomiting.

  • Increased thirst.

Risk factors Ovarian hyperstimulation syndrome(OHSS)

Sometimes, OHSS takes place in women with no hazard factors in any respect. But elements which are known to increase your risk of OHSS encompass:

  • Polycystic ovary syndrome — a commonplace reproductive ailment that causes abnormal menstrual intervals, extra hair boom and uncommon look of the ovaries on ultrasound examination

  • Large number of follicles

  • Age under 35

  • Low body weight

  • High or steeply increasing level of estradiol (estrogen) before an HCG trigger shot

  • Previous episodes of OHSS

Complications Ovarian Hyperstimulation Syndrome

Women with OHSS are at threat for developing a thrombosis (blood clot) inside the lungs or legs. Medicines can help decrease your hazard for this trouble. Tell your healthcare provider in case you enjoy a painful, swollen leg or chest ache.

In uncommon instances, an ovarian cyst related to OHSS can burst. Women with this trouble can also need surgical treatment to prevent the damaging bleeding which can arise as a result.Severe ovarian hyperstimulation syndrome is uncommon, however may be existence-threatening. Complications may also consist of:

  • Fluid collection in the abdomen and sometimes the chest

  • Electrolyte disturbances (sodium, potassium, others)

  • Blood clots in large vessels, usually in the legs

  • Kidney failure

  • Twisting of an ovary (ovarian torsion)

  • Rupture of a cyst in an ovary, which can lead to serious bleeding

  • Breathing problems

  • Pregnancy loss from miscarriage or termination because of complications

  • Rarely, death

Can OHSS go away on its own?

Yes OHS can go away on its own It is important to note that if the ovaries are severely damaged by the hormone injections it may take a long time for them to recover If the ovaries are damaged there is an increased risk of infertility and premature menopause In cases of severe damage women may require hormone therapy in order to prevent premature menopause.

Does drinking water help with OHSS?

The most common symptom of ovarian hyperstimulation syndrome is bloating. Water helps to alleviate this symptom because water is a diuretic and will help the body release excess fluids. Drinking lots of water can also reduce the other symptoms by increasing urine production.

How long does hyperstimulation ovarian last?

During hyperstimulation ovarian (HOS) the physician may give the patient a medication that causes multiple eggs to mature at once This produces an excess of immature eggs which are removed from the ovaries during the retrieval process An egg can be fertilized for approximately 12 to 24 hours after it is retrieved.

Can you still get pregnant with OHSS?

The answer is yes Ovarian hyperstimulation syndrome (OHSS) is a complication that occurs when women are stimulated to produce many eggs during in vitro fertilization (IVF) Women with this condition may experience abdominal pain nausea and vomiting fluid retention and shortness of breath OHSS can also cause blood clots or other potentially fatal complications With proper treatment the majority of women who experience OHSS will recover However if you do not seek immediate medical attention your symptoms could worsen and lead to serious health problems such as heart failure or kidney failure.

Does hyperstimulation affect egg quality?

The reproductive endocrinology unit at the University of California in San Francisco says that hyperstimulation affects egg quality This is because it triggers the release of hormones that stimulate ovaries to produce more eggs than normal It can also cause excessive follicle growth and stimulation of the ovaries The result is development of cysts on the ovaries which can become hard and painful if not treated properly.

Can OHSS cause miscarriage?

The syndrome is caused by the stimulation of ovaries by fertility drugs which results in a buildup of fluid in the abdomen and chest This can cause dangerous health problems including blood clots and heart attacks The good news is that most women who are diagnosed with OHSS do not lose their babies.

Prevention Ovarian Hyperstimulation Syndrome

If you’re present to process fertility remedies, having a plan tailor-made to you may preserve your hormone levels solid. To lower your possibilities of developing ovarian hyperstimulation syndrome, you'll need an individualized plan on your fertility medicines. Expect your health care company to cautiously monitor every treatment cycle, together with frequent ultrasounds to test the improvement of follicles and blood checks to check your hormone degrees.

Strategies to assist save you OHSS include:

  • Adjusting medication. Your company uses the lowest possible dose of gonadotropins to stimulate your ovaries and cause ovulation.

  • Adding medication. Some medicines appear to reduce the chance of OHSS without affecting the odds of being pregnant. These consist of low-dose aspirin; dopamine agonists which include cabergoline or quinagolide; and calcium infusions. Giving women who've polycystic ovary syndrome the drug metformin (Glumetza) during ovarian stimulation may help save you from hyperstimulation.

  • Coasting. If your estrogen degree is excessive or you have got a huge wide variety of advanced follicles, your company may have you forestall injectable medicines and wait some days earlier than giving HCG, which triggers ovulation. This is known as coasting.

  • Avoiding use of an HCG trigger shot. Because OHSS frequently develops after an HCG trigger shot is given, alternatives to HCG for triggering have evolved the use of Gn-RH agonists, inclusive of leuprolide (Lupron), as a manner to prevent or limit OHSS.

  • Freezing embryos. If you're undergoing IVF, all of the follicles (mature and immature) may be removed from your ovaries to reduce the chance of OHSS. Mature follicles are fertilized and frozen, and your ovaries are allowed to rest. You can resume the IVF method at a later date, when your body is prepared.

Diagnosis Ovarian hyperstimulation syndrome(OHSS)

If you are receiving fertility remedy and begin to revel in signs and symptoms of OHSS, inform your physician. They may perform some of the subsequent tests to diagnose the situation.Ovarian hyperstimulation syndrome analysis may be primarily based on:

  1. Gynecological examination

  • A physical exam. Your issuer will search for any weight advantage, increases for your waist length and stomach pain you may have.

  • An ultrasound. If you have got OHSS, an ultrasound may additionally display that your ovaries are bigger than ordinary, with massive fluid-crammed cysts where follicles develop. During remedy with fertility pills, your issuer frequently evaluates your ovaries with a vaginal ultrasound.

  • A blood test. Certain blood checks allow your issuer to test for abnormalities to your blood and whether or not your kidney feature is being impaired because of OHSS.

Treatment Ovarian hyperstimulation syndrome(OHSS)

OHSS may be serious, so careful monitoring and coping with the symptoms are vital each time it takes place. Office visits for ultrasound checks to degree the ovaries and fluid within the abdomen, and blood exams, are routinely executed. Decreased activity and ingesting plenty of electrolyte-wealthy fluids (over one hundred twenty oz in line with day) are recommended. Medicines for nausea are to be had. If there may be fluid inside the abdomen, drainage of fluid the use of a syringe (paracentesis) can provide substantial comfort in most instances. In any event, a couple of drains is useful. A medication known as cabergoline can also reduce the fluid accumulation. There is rarely a need for hospitalization.

If OHSS does no longer improve with outpatient care, the female may be handled within the health facility with near monitoring. The medical doctor may also order intravenous (IV) fluids and drugs for nausea and may cast off fluid from the stomach. Other supportive therapy may be given as needed.

Ovarian hyperstimulation syndrome commonly resolves on its personal inside a week or  or relatively longer if you're pregnant. Treatment is geared toward retaining you cozy, decreasing ovarian activity and warding off complications.

Mild to moderate OHSS

Mild OHSS usually resolves on its own. Treatment for mild OHSS can also involve:

  • Increased fluid intake

  • Frequent physical exams and ultrasounds

  • Daily weigh-ins and waist measurements to check for drastic changes

  • Measurements of how much urine you produce each day

  • Blood tests to monitor for dehydration, electrolyte imbalance and other problems

  • Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity

  • Medications to prevent blood clots (anticoagulants)

Severe OHSS

With severe OHSS, you would need to be admitted to the health center for monitoring and aggressive treatment, along with IV fluids. Your company may also give you a remedy referred to as cabergoline to lessen your signs. Sometimes, your provider might also give you other medications, consisting of gonadotropin-freeing hormone (Gn-RH) antagonist or letrozole (Femara) — to help suppress ovarian interest.

Serious complications may require extra remedies, including surgical treatment for a ruptured ovarian cyst or in depth take care of liver or lung headaches. You may also want anticoagulant medicinal drugs to lower the threat of blood clots in your legs.

Lifestyle and home remedies

If you develop moderate ovarian hyperstimulation syndrome, you will likely be able to continue your every day routine. Follow your company's recommendation, which can also include those pointers:

  • Try an over the counter painkiller which include acetaminophen (Tylenol, others) for abdominal pain, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have these days had an embryo switch, as these pills can interfere with implantation of the embryo.

  • Avoid sex, as it may be painful and can cause a cyst in your ovary to rupture.

  • Maintain a light physical activity level, avoiding strenuous or high-impact activities.

  • Weigh yourself at the same scale and measure around your abdomen each day, reporting uncommon will increase to your company.

  • Call your provider if your signs and symptoms get worse.

Preparing for your appointment

Depending on how intense your ovarian hyperstimulation syndrome is, your first appointment can be with your primary care provider, your gynecologist or infertility specialist, or possibly with a treating medical doctor in the emergency room.

If you have time, it's an amazing idea to put together in advance of your appointment.

What you can do

  • Write down any symptoms you're experiencing. Include all of your signs and symptoms, even if you do not assume they're associated.

  • Make a list of any medications and vitamin supplements you take. Write down doses and how frequently you are taking them.

  • Have a family member or close friend accompany you, if possible. You may be given a whole lot of facts at your go, and it is tough to recall the whole lot.

  • Take a notebook or notepad with you. Use it to write down important information during your visit.

  • Prepare a list of questions to ask your provider. List your most important questions first.

Some basic questions to ask include:

  • What's the most likely cause of my symptoms?

  • What kind of tests do I need?

  • Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?

  • Do you have any printed material or brochures I can take home with me? What websites do you recommend?

Make sure that you completely recognize the whole thing that your provider tells you. Don't hesitate to ask your issuer to repeat information or to invite follow-up questions for explanation.

What to expect from your provider

Some potential questions your provider might ask include:

  • When did your symptoms begin?

  • How severe are your symptoms?

  • Does anything make your symptoms better?

  • Does anything seem to make your symptoms worse?

General summary

  1. Ovarian hyperstimulation syndrome is a common side effect of ovarian stimulation and it occurs in about 1 out of every 20 women who undergo fertility treatments The condition occurs when ovaries react to high levels of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) Ovarian hyperstimulation syndrome can be mild or severe but the most serious cases require hospitalization.

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