Ovarian Hyperstimulation Syndrome (OHSS) can only happen when undergoing an In Vitro Fertilization (IVF-ICSI), that is, when stimulating the ovaries by the intake of gonadotropins. Its incidence nowadays is low, around 10%, and it is generally of mild intensity, but in the exceptional case that the intensity was higher, we are facing with the most serious problem that may occur when carrying out In Vitro Fertilization (IVF-ICSI).
The origin of this syndrome is not exactly known, however, the main cause is the increase of the permeability of the blood vessels, due to an increase in the VEG protein, which increase the porosity of the walls of the blood vessels, causing intravascular fluid leaking out in the peritoneal cavity (Ascites)
The most relevant predisposing factors are: women under 35 years of age, underweight, presence of many follicles in the ovaries (as within polycystic ovaries), and when reaching high level of estrogen during the stimulation cycle.
Symptoms usually appear between three and ten days after ovulation, and can quickly worsen in the event of pregnancy. Symptoms are generally mild such as: difficulty breathing, poor fluid tolerance, nausea, vomiting, bloating, pelvic pain, decreased urination, and weight gain within a few days. In the event that abdominal pain and bloating increases, the patient should be referred to hospital admission.
In order to prevent this syndrome, it will be necessary to use low doses of gonadotropins, control of level of estrogens in blood, induce ovulation with a fast-acting and little persistent preparation so that high hormonal levels revert faster. Obviously, since the pregnancy worsens the symptoms, the embryo transfer should be postponed, the embryos (or eggs) would be vitrified, and so, the embryo transfer could be done later on.
On the other hand, mild hyperstimulation only required drinking plenty of water, 10-12 glasses every day, avoid intense exercising and sexual intercourse, and the patient can take painkiller (Paracetamol) if necessary. Initially, it is important to monitor the patient every 48 hours and, if symptoms worsen, she must be referred to hospital admission.
CONCLUSIONS
OHSS never appears spontaneously, it can only happen within ovarian stimulation during a cycle of In Vitro Fertilization (IVF-ICSI) or donation of oocytes (egg donation)
Nowadays, it happens less often due to new medications and the strategy of delaying embryo transfer.
When, despite everything, it happens, it will be necessary to have a very rigorous control, knowing that its persistence or aggravation may require hospital admission.
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Gregorio Manzanera
IMAGE: Volume Segmentation and Reconstruction from Freehand Three-Dimensional Ultrasound Data with Application to Ovarian Follicle Measurement (Mark J Gooding et al.)
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