Ovarian Hyperstimulation Syndrome

When should I be concerned about Ohss?

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When should I be concerned about Ohss?

It’s important to get immediate treatment if you experience severe symptoms and have any risk factors of OHSS. Issues like blood clots, trouble breathing, and severe pain may lead to more serious complications, like an ovarian cyst rupture with excessive bleeding.

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Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome is a potentially life-threatening complication of ovulation induction.

Much effort has been made to try to understand the factors responsible for the emergence of this syndrome. In recent years, several factors have been proposed, such as: the renin-angiotensin system, histamine, prostaglandins, and recently, there is much talk about cytokines – and the growth index called VEGF, but it must be noted that until today, none of these factors has been proven , as a cause of the syndrome.

The prevalence of the syndrome decreases as its severity increases.
This syndrome in mild severity occurs in 8% to 23% of women who receive treatment to stimulate ovulation. Moderate severity in 1% – 7% of women receiving this treatment, and severe severity in less than 2% of women treated. The syndrome is usually more difficult and persistent, when treatment is successful and the treated woman becomes pregnant.

Over the years, a number of classifications of the syndrome have been proposed, based primarily on its degree of severity, while the following classification has recently been adopted:

Mild: flatulence and abdominal discomfort, with or without nausea, vomiting and/or diarrhea, and swelling of the ovaries, each up to 5 centimeters in diameter.

Intermediate degree: characteristic, as in mild severity, with evidence of ascites. Enlarged ovaries, up to 12 centimeters in diameter, by ultrasound.

Serious grade: pronounced abdominal ascites, fluid in the chest cavity, high blood viscosity (hematocrit “hematocrit” above 45%), decreased urination with creatinine levels, 1 – 1.5 mg per 100 ml of urine, liver disorders, tumors and general bulges.

Extremely severe (critical): severe ascites with fluid in the chest cavity, high blood viscosity (hematocrit above 55%), decreased urination with creatinine levels above 1.5 mg per 100 ml of urine, kidney failure , clots and blood clots, Vascular obstruction and signs of respiratory crisis in adults.

Symptoms of ovarian hyperstimulation syndrome

Symptoms of ovarian hyperstimulation syndrome always begin to appear, after the administration of ovulatory hormones (hCG) or at the beginning of pregnancy , and its main characteristics are severe enlargement of the ovaries and fluid transfer and accumulation in the cavities of the third section.

This fluid transfer, which is responsible for disease and death as a result of this syndrome, occurs due to increased permeability of blood vessels (their ability to pass fluids) and leads to fluid accumulation in the peritoneal cavity, chest cavity and heart, swellings and tumors under the skin (the cavities of the third section). As a result of this, a decrease in blood volume, an increase in its viscosity and coagulation level, disturbances in the balance of fluids and salts, a decrease in urine excretion, and even kidney failure occur.

Causes and risk factors for ovarian hyperstimulation syndrome

There are a number of cases that have been linked to the occurrence of the syndrome, and have been raised as risk factors for its emergence, including:

  • Early generation of the patient (less than 35 years).
  • Low body weight.
  • Women with polycystic ovary syndrome.
  • Women whose response to induction of ovulation experienced elevated estrogen levels and a large number of follicles stimulated on the day of hCG, or a large number of eggs were retrieved during IVF treatment.
  • Giving hCG as a boost in post-ovulation during the menstrual cycle.

Ovarian hyperstimulation syndrome treatment

The treatment of ovarian hyperstimulation syndrome is a preventive treatment, and aims to prevent serious complications of this syndrome without allowing its prolongation.

Treatment includes rest, drinking plenty of fluids, and monitoring for signs and symptoms that may indicate they are getting worse.

Mild and moderate degrees of the syndrome generally disappear on their own, and often require close monitoring and follow-up without the need for a hospital stay.

In the event that an aggravation is detected and has reached a serious or critical (very dangerous) degree, the patient must be hospitalized (staying in the hospital). During the hospital stay, you must rest completely. Weight should be measured on a daily basis, follow-up data, biometrics, and frequent physical examination to assess the possibility of fluid in the cavities of the third section.

Fluid levels should be carefully monitored (the amount of fluid drunk and the volume of urination) and frequent laboratory tests to measure blood viscosity, salts and coagulation conditions in the kidneys and liver.

Treatment includes giving fluids through the mouth or intravenously, with the aim of preventing the increase in blood viscosity, and allowing the kidneys to purify the blood adequately, which is measured by the amount of urine excreted.

In some cases where there is a decrease in the proportion of proteins in the blood and aggravation of the passage of fluids into the lumen of the third section, there is the possibility of injecting colloidal substances (albumin or dextron). Also, the exacerbation of the condition is in some cases in the form of the accumulation of a large amount of ascites fluid, with a feeling of breathing difficulties and a decrease in the amount of urine. It is possible for this case to require pricking the abdomen several times in order to empty the accumulated fluids and facilitate breathing and the functioning of the kidneys.

It is very rare for things to escalate to the point of posing a life-threatening condition that requires termination of pregnancy.

Prevention of ovarian hyperstimulation syndrome

Several means have been proposed to prevent and reduce the prevalence and severity of this ovarian hyperstimulation syndrome. While abstaining from taking hCG only prevents the emergence of the syndrome, the efficacy of each of the following methods is still under discussion:

  1. Stimulation of ovulation with close monitoring and prevention of acute reactions of the patient’s ovaries, as a result of one of the above-mentioned risk factors. Reducing the dose of hCG that causes ovulation.
  2. Postpone ovulation-stimulating drugs and hCG, while continuing and waiting for estrogen levels to drop to safe levels.
  3.  During ovulation induction cycles in which GnRH-stimulators have not been administered , ovulation-stimulating GnRH-stimulators may be given instead of hCG.
  4. Freezing the embryos and canceling their return to the uterus during the current cycle, thus preventing pregnancy, which is only possible, increases the risk and severity of the syndrome.
  5. Giving albumin or hydroxyacethyl starch during egg extraction in the in vitro fertilization cycle.

Refrain from administering hCG as a support component during the “luteal phase” (phase) of ovulation.

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