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What is Ovarian Hyperstimulation Syndrome?

OHSS can affect women who are taking drugs to stimulate their egg production, but what is it?

Posted: 31 December 2007
by Laura Lee Davies

Ovarian Hyperstimulation Syndrome, as its name suggests, is caused when drugs taken to kickstart or enhance the production performance of a woman’s ovaries, bring about over-activity. It can be a serious condition, but it only affects women who are going through certain forms of assisted conception, fertility treatments such as IVF.

What is Ovarian Hyperstimulation Syndrome?
Very rarely, the drugs a woman is taking to increase ovary production can cause her body to over-react. This makes her ovaries swell up, consequently leaking fluid into the abdomen and sometimes into other areas around vital organs such as the heart. The chemical reaction brought about, as well as the volume of fluid, can cause serious problems affecting the liver, kidneys and lungs. It affects the body’s urine production. In a very small number of cases, the condition has proved fatal.
Where it has been treated, there are no studies to suggest there is damage to the baby.
The clinic where you are getting your fertility treatment should issue you with information about OHSS and a contact number for them in case you have any emergency concerns. There are some other medical conditions, such as an ectopic pregnancy, which can bring about similar symptoms and can be diagnosed and dealt with accordingly.

How do you know if you are suffering from OHSS?
For a start, do not worry about the possibility, even, of OHSS unless you are on drugs to stimulate ovarian production.
Depending on the severity of the condition, the symptoms appear in a range of forms. Mild symptoms come on in the form of feeling sick and having stomach pain with slight abdominal swelling, and weight gain. Mild symptoms are usually only monitored and can be addressed by care and rest at home. Moderate symptoms reveal themselves as a more extreme version of the mild symptoms. The stomach pain will be more severe and there is more likely to be vomiting rather than just nausea. You should speak to your doctor or midwife team if you have these symptoms. Severe symptoms manifest themselves in more marked ways. If you have any of the following symptoms you should seek emergency medical help: only being able to produce small amounts dark urine, trouble breathing, you feel thirsty because you are dehydrated, you have a swelling in your leg or it feels red, hot and tender (this can be caused by a blood clot).

I’m having IVF, am I at risk?
The risk of developing OHSS during a course of IVF treatment is raised in women who already have the condition PCOS or who have experienced OHSS before. It also tends to be more common if you are having treatment when you are under 30 years old (this is believed to be because the body is more likely to respond more strongly to the stimulation). It is thought that low body weight might also be a factor.
If your treatment is successful, pregnancy can also bring on the condition, especially if you are expecting more than one baby.
It is believed that as many as a third of women undergoing IVF treatment will experience mild OHSS, but only about five per cent will develop moderate or severe OHSS.
Very occasionally other forms of fertility treatment might bring on OHSS.

What happens if I get OHSS?
Mild symptoms are quite common and can be addressed by rest and care at home. Pain can be addressed by using paracetamol (but not aspirin or drugs like ibuprofen), but make sure you tell the pharmacist why you need them to make sure you are not taking a medication that might affect your kidneys. Rest (and try avoid anything too strenuous, including having sex), but make sure you move about regularly, and keep yourself hydrated with clear fluids, within over-drinking.
Mild symptoms usually clear up after a few days, unless you have become pregnant during this course of IVF treatment, in which case the symptoms may last longer and require further investigation to ensure they don’t get worse. (If your treatment wasn’t successful, your symptoms will clear up as your menstrual period arrives.)
If your symptoms do not get better, if pain killers do not help or you experience the other symptoms of moderate or severe OHSS (above), contact emergency medical help straight away.
You can then be assessed to see if you need immediate treatment to alleviate the symptoms, either at home or in hospital. In extreme cases you may have to stay in hospital while the condition’s symptoms are resolved. If you are at home, you will be checked regularly.

Will I have to stop having fertility treatment?
The kinds of treatment you are receiving can be altered to remove those elements most likely to cause OHSS. After full consultation with your specialist, further treatment can be possible.

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