Ovarian Hyperstimulation Syndrome | When IVF Treatment Goes Wrong

The medical condition called Ovarian Hyperstimulation Syndrome (OHSS) is getting more common with increasing inclination of prospective parents towards IVF. The medical facility such as IVF is no doubt a blessing for humankind but also has its own side effects.  For instance, stimulating egg growth with the help of allopathy medicine can go wrong and lead to OHSS which can cause severe sickness or even prove fatal. This article is written to increase awareness of OHSS and its related treatment.

Shreya’s journey through OHSS and infertility:

What Went Wrong At the Outset?

OHSS is a side effect of hormonal treatment, basically due to higher dose of HCG.  It is, however, important to understand that the doses can differ from women to women. Women struggling with PCOD are more vulnerable when compared to others. Shreya hyperstimulated during IUI when 75 units of HCG was given in the course of the treatment. She produced about 7-8 follicles and they were of good quality. However, she changed her doctor midway during her first IVF and the new doctor injected another 150 units of HCG into her body. She was told by the new doctor that the increased dose of HCG is to enable her to produce more eggs as more eggs are always better. The doctor was unaware of her previous hormonal doses (that she was previously hyperstimulated for 75 units).

No Proper Guidance:

The previous doctor never informed Shreya that she is already hyperstimulating and posed a problem at a later stage. With extra doses and more eggs, Shreya was very happy and she eventually conceived during that period. However, she had to go through abdominal pain as follicle rupture resulted in a lot of fluid releases. She had severe cramps and blotting but she was told by the new doctor that she is producing healthy eggs.

Repeated Mistakes and How It Affected the Ovaries:

Once again Shreya changed her doctor who informed her that she has been hyperstimulated due to continuous shifting in the course of the treatment. By that time she had 15 follicles and most of them were healthy, and she was all prepared for egg retrieval, where, they puncture the ovaries to suck the eggs out of the follicle. Shreya had 13 eggs retrieved as two of her follicles were not matured at that time. Her ovaries were punctured several times during the process but the quality of eggs was average.

What Freaked Shreya Out?

In the course of her treatment for 5 years her body was bombarded with a lot of hormones and medicines to which her body finally revolting against. PCOD patients are more vulnerable to OHSS, and Shreya also had mild PCOD. She used to get her periods regularly but her ovaries were polycystic. The high amount of ovary punctures also increased her stimulation rate. At that time she was bloating which the doctor said was normal and when she woke up at midnight to puke. She noticed that her abdomen was heavily bloated and she looked like someone who was 7 or 8 months pregnant. This freaked her out and she called her doctor the next morning. She rushed to the clinic to get a scan done. The report showed that both her ovaries were swollen to 11.8 cms, where normally ovaries are 3-4 cm in size. This meant that she definitely had a case of extreme ovary enlargement.

She was immediately admitted to the hospital and was put on injections. It took 3-4 days for her ovaries to reduce to its normal size.  But all was not OK yet. There was fluid accumulation in her lungs which was a further cause for worry. However, she slowly recovered and was shifted to the general ward in a week. Her embryo transfer for IVF was delayed for that cycle as she had just recovered from OHSS because even if she did go for embryo transfer, the chances of success in this cycle were slim. Yet, when the embryo transfer was done in the next cycle, it failed! Why?

All’s Well Finally:

Shreya began to understand that it is important at this stage to detox her body first and this took her another six months. Once that was done, she conceived naturally. Shreya ’s story is a huge example of caution other women of Ovarian Hyperstimulation Syndrome, especially the ones who are undergoing treatment for fertility.

The Basics of Ovarian Hyperstimulation Syndrome One Should Know:

If any of you reading this are taking a treatment for infertility, the first thing you should know is the different levels of OHSS to determine where exactly you stand. It is classified into four major categories including mild, moderate, severe, and critical.

Mild Ovarian Hyperstimulation Syndrome:

  • Class 1 - Uneasiness and discomfort in the abdominal area.
  • Class 2 – Both the above symptoms with vomiting, nausea, diarrhea, and ovarian enlargement of 5-12 cm.

Moderate Ovarian Hyperstimulation Syndrome:

  • Class 3 – All the symptoms of Class 1 & 2 with ultrasonographic evidence of ascites (abnormal accumulation of fluid in the abdominal).

Severe Ovarian Hyperstimulation Syndrome:

  • Class 4 - All the symptoms of Class 1, 2 & 3 with breathing difficulties and/or hydrothorax (fluid accumulation in the pleural cavity).

 Critical Ovarian Hyperstimulation Syndrome:

  • Class 5 - All of the above symptoms with increased blood viscosity due to hemoconcentration, diminished renal function, change in blood volume and coagulation abnormalities.

The side effects can be increased ovary size due to over stimulation. The patient and medical practitioner must be aware of this fact before deciding on any infertility treatment. One of the well-known infertility treatment is gonadotropin therapy (where HCG injections are given to the prospective woman to increase her egg production)  that many couples opt for without any prior knowledge of its consequences. It sometimes leads to OHSS after a brief period of oocyte retrieval.

To put it simply, Ovarian Hyperstimulation syndrome (OHSS) is a medical condition of ovarian enlargement due to several ovarian cysts.

Ovarian Hyperstimulation Syndrome and Fertility Treatment/ IVF

Although HCG has been blamed for causing this condition, the truth is that the whole concept of disease inception is still not fully explored. The Gonadotropin hormone is naturally produced during pregnancy. On the other hand, when it is induced into the body artificially to trigger egg release from the mature follicle, ovarian blood vessels react weirdly to it. They start with leaking fluids that leads to ovary swelling and huge movement in the abdomen.

It has seen that OHSS normally occurs after few weeks of injecting HCG into the body. The worst situation is if you get pregnant during this period then OHSS interferes with the natural production of HCG by the body in response to the pregnancy. Fertility treatment that includes oral doses of medication such as clomiphene is less prone to causing OHSS than taking HCG injections. There are other factors too that increases your chances of getting OHSS.

4 Factors That Increases The Risk Of Ovarian Hyperstimulation Syndrome

  • Age – If you are under 30 and considering taking HCG injection then be aware of OHSS risks.
  • High Estrogen level – Patients with high level of estrogen before taking HCG injection are more likely to be affected by OHSS.
  • Low weight – Low body weight is again one of the primary causes of OHSS.Many women work towards a slimmer look but they are more at
  • PCOS – Polycystic ovary syndrome or PCOS is a reproductive disorder associated with irregular menstruation cycle. Patients with PCOS are more prone to getting affected by OHSS.

These are some of the chief causes. However, there are instances where a woman with none of the above risk factor encountered Ovarian Hyperstimulation Syndrome after HCG treatment.

So, what then is the solution? How does one keep OHSS at bay? Diet is one of them. Let’s see how.

Diet To Minimize Ovarian Hyperstimulation Syndrome

If you are undergoing any fertility treatment that might lead to OHSS then you must redesign your diet accordingly. Include lots of high protein food and fluids in your daily diet along with an increased amount of salt.

Protein is a must diet content for those who are undergoing fertility treatment. Protein substrates albumin production that reduces ascites. Lack of protein leads to reduced albumin production which is a big cause of Ovarian Hyperstimulation Syndrome.  You must include meat or pulses in your daily diet.

Coconut water is the best thing that you must have to minimize OHSS. It provides the adequate amount of sodium and potassium that renal perfusion requires. You can also drink energy beverages whenever you feel your lips or mouth is going dry. Doing this will help you from getting concentrated urine or dry mucous membrane.

Extra salty food is good for getting the adequate amount of sodium and potassium that your body needs. Low sodium and potassium can lead to tiredness and low appetite that increase the chances of OHSS.

You can also take a small amount of aspirin to control blood clotting in severe cases but only if your doctor prescribes it. Pain medication can be also taken to control pain but again only as per doctor’s prescription.

Why Ovarian Hyperstimulation Syndrome Needs More Attention?

Ovarian Hyperstimulation Syndrome can be controlled with proper diet and medical care and only 5% of IVF cases shows OHSS syndrome in the world. There is no need to panic thinking about this medical condition but one must need to be aware of the consequences of IVF treatment. Moreover, if you lead a healthy lifestyle with proper diet then it is possible that you conceive naturally and will not need any fertility treatment. However, if you face this unfortunate and painful condition you must consult a dietitian along with medical care. There are specialized fertility nutritionists who are experts in charting a diet for OHSS and IVF patients. They could help you solve the problem.





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