OHSS – A hurdle in your IVF journey!
Mrs. ABC was chosen as an ideal candidate for an IVF cycle. Though unable to get pregnant naturally, she was young, in good health, but suffered from PCOS (Polycystic ovarian syndrome-having multiple eggs in her ovaries). Days after she began taking fertility injections, even the smallest tailored dose made her ovaries swell up with multiple eggs. This scenario can lead to a condition called the Ovarian Hyperstimulation syndrome, OHSS in short; which is a rare complication of fertility treatment. Though modern fertility treatments do not have any long-term side effects, OHSS is a potentially dreaded complication which can occur mostly in PCOS patients. It usually occurs post the egg retrieval process. Affecting around 10% of women, it is classified into mild, moderate and severe forms. It can occur even when the stimulation protocol is designed to fit an individual woman. While we can exercise control over the dose to be given, we cannot control the response to the stimulation. Some women’s ovaries respond slightly stronger leading to OHSS. Risk factors include younger age, development of many ovarian follicles under stimulation, extreme elevated estradiol levels and use of HCG injection for final maturation of eggs. It rapidly intensifies when pregnancy occurs due to increased HCG hormone in the circulation!
A lot of research says that OHSS occurs due to release of a special chemical called the VEGF, by the ovaries. This VEGF acts on the blood vessels, causing them to leak fluid into the abdominal and lung cavities. This extra fluid building up in the body can trigger certain symptoms like bloating, nausea, difficulty in breathing, abdominal pain and decreased urination. Early OHSS develops before pregnancy and late OHSS is seen in early pregnancy.
How do we treat this condition?
Mild to moderate OHSS is usually self-resolving with proper observation, plenty of fluids and medications to calm your ovaries. Severe OHSS, although very rare, requires hospitalization with intensive monitoring. This includes regular blood tests and an ultrasound to check on the ovaries.
Prevention is always better!
OHSS does not hurt your chances of achieving a pregnancy. However, it is best to delay pregnancy until the risk of OHSS is warded off. There are some tried and tested ways to prevent OHSS, like:
- Using lower dose injectable medications & counseling the patient regarding OHSS prior.
- Cancelling the current cycle.
- With-holding the HCG trigger injection/using another (agonist) injection as trigger.
- Freezing all the embryos in the first cycle and transferring in the next cycle to prevent OHSS and also get better success rates.
- We, at Gynaecworld are extremely careful in avoiding any incidences of OHSS by conservative management of medications and by patient education. We believe in an OHSS-free clinic and have set protocols to ensure the same. Our goal is to get all our patients safely and successfully through their fertility journey.