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Ovarian hyperstimulation syndrome (OHSS) is a complication occasionally seen in women who take certain fertility medicines that stimulate egg production.
See also: Infertility
Normally, a woman produces one egg per month. Some women undergoing fertility treatments are given medicines to help normalize egg development or increase egg production.
However, if the drugs stimulate the ovaries too much, the ovaries can suddenly become very swollen and fluid can leak into the belly and chest area. This is called ovarian hyperstimulation syndrome (OHSS). OHSS occurs only after the eggs are released from the ovary (ovulation).
You may be more likely to get OHSS if your doctor gives you an injection of a hormone called human chorionic gonadotropin (hCG) to help trigger ovulation. You may have an even greater risk of this syndrome if you receive more than one dose of hCG after ovulation and if you become pregnant during this cycle. OHSS rarely, if ever, occurs in women who only take fertility medicines by mouth.
OHSS affects up to 10% of women who go through in vitro fertilization. In most cases the condition is mild, but some women get a severe and dangerous form of OHSS.
Additional risk factors for OHSS include:
The symptoms of OHSS can range from mild to severe. Most women with the condition have mild symptoms such as:
In rare cases, women can have more serious symptoms, including:
If you have a severe case of OHSS, your health care provider will need to carefully monitor your symptoms. You may be admitted to the hospital.
Your weight and size of your belly area (abdomen) will be measured. Tests that may be done include:
Mild cases of OHSS usually don't need to be treated. You can ease your discomfort by doing the following:
You should weigh yourself each day to make sure you are not putting on too much weight (5 or more pounds a day).
In the rare case that you develop severe OHSS, you will probably need to go to a hospital. The health care providers there will give you fluids through a vein (intravenous fluids), remove fluids that have collected in your body, and monitor your condition.
Most mild cases of OHSS will go away on their own after menstruation starts. If you have a more severe case, it can take several days for symptoms to improve.
If you become pregnant during OHSS, the symptoms may get worse and can take weeks to go away.
In rare cases, OHSS can lead to life-threatening complications, including:
Call your healthcare provider if you experience any of the following symptoms:
If you are receiving injections of fertility medicines, your doctor will monitor you carefully with blood tests and pelvic ultrasounds to make sure that your ovaries aren't over-responding.
If your estrogen level rises very high or very quickly while taking fertility injections, your risk for OHSS is increased. You may need to take a lower dose of the medicines or temporarily stop treatment.
Some women may be given a protein solution called albumin to reduce the chances of OHSS.
Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.
Speroff L, Fritz MA. Induction of ovulation. Speroff L, Fritz MA, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2005:chap 31.