Overstimulation of the ovaries (Ovarian Hyperstimulation Syndrome)

In IVF treatment, as in any treatment, some adverse complications may develop. Overstimulation of the ovaries (ovarian hyperstimulation syndrome-OHSS) is one of the most common complications of IVF treatment. The biggest reason for this problem to occur is the exposure of the ovaries to the drug more than necessary.

IVF
Prof. Dr. Ulun ULUĞ
Written by Prof. Dr. Ulun ULUĞ. 0 comments 4858 views

Overstimulation of the ovaries (Ovarian Hyperstimulation Syndrome)

Overstimulation of the ovaries syndrome is also common in women with polycystic ovary syndrome (PCOS). Because ovarian reserve is different in these patients compared to other women, it may not be easy to adjust the ideal dose. In such patients, insufficient drug dose may cause ovaries to not develop, while overdose may cause ovarian hyperstimulation (ovarian hyperstimulation syndrome).

problem of overstimulation of the ovaries is a common problem in IVF treatment, the probability of severe cases is around 5%.

In case of overstimulation of the ovaries, the reduction of egg-enhancing drugs and the administration of the drug can be interrupted for a day or longer as recommended by the doctor. Thus, the excessive rise of the estrogen hormone secreted from the ovaries is prevented and the exacerbation of the situation is prevented.

If pregnancy occurs during treatment, the hyperarousal syndrome may become more severe. For this reason, in the presence of ovarian overstimulation syndrome, the treatment should be stopped under the supervision of a doctor.

Symptoms of ovarian hyperstimulation syndrome

  • Excessive increase in ovarian size on ultrasound examination
  • Abdominal and groin pain
  • Feeling of excessive bloating
  • Shortness of breath,
  • Decrease in the amount of urine, burning, constant desire to go to the toilet,
  • Fluid accumulation in the abdominal and thoracic cavities
  • Problems with coagulation 

What to do

To prevent the increase in the severity of ovarian hyperstimulation syndrome;

  • Interruption or reduction of egg-enhancing drugs according to the situation,
  • Reducing the dose of cracking needle,
  • Postponing the day of the egg retrieval (OPU) procedure,
  • Postponing the embryo transfer process if the egg has been collected,
  • If embryo transfer is decided according to the condition of the syndrome, it is necessary to prevent multiple pregnancy by reducing the number of embryos to be transferred.

Risks of Ovarian Hyperstimulation Syndrome

Severe bleeding in the ovaries may occur as a result of the slightest trauma in patients who experience the process severely. As a result of bleeding, a painful condition called “torsion” may occur and requires urgent surgical intervention.

In cases where ovarian hyperstimulation syndrome is severe, patients may have difficulty in breathing due to fluid accumulating in the abdomen and chest cavities. Even though they are breathing deeply, they cannot get enough oxygen because of the fluid accumulated in their lungs and they feel like they are suffocating.

In addition, since it can cause coagulation problems, clots occur due to irregularity and the functions of vital organs such as the brain and lungs may be impaired.

Treatment

Hospitalization is not required in cases where ovarian overstimulation, in medical terms, ovarian hyperstimulation syndrome (OHSS) is not severe.

First of all, drugs are reduced or completely stopped in treatment. The patient is asked to reduce salt and fluid intake, and daily weight and abdominal circumference are measured and monitored. In the meantime, if deemed necessary according to the severity of the situation, the effects of some special serums and oral tablet drugs are tried to be minimized.

In the measurements made, the patient should have an increase in abdominal circumference of more than three centimeters in a day and body weight should increase by more than two kilograms. In addition, when complaints such as decreased daily urine amount, increased abdominal tension, and shortness of breath begin to occur, it is necessary to inform the physician.

In cases where ovarian hyperstimulation syndrome (OHSS) is severe, it should be treated by hospitalization. Special medications should be given to the patient and daily blood tests and ultrasound examinations should be observed. Depending on the severity, draining the fluid accumulated in the patient's abdomen with the help of a needle (paracentesis) will help reduce the severity of the problem.

In cases where the overstimulation of the ovaries is very severe, the discharge period of the patient may extend up to 2-3 weeks.

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