For a lot of women going through IVF it is a straightforward part of their conception journey, but sometimes there are complications they don’t expect. One of these complications can be OHSS, which can sound concerning, but it doesn’t have to be scary- especially with the right support!

Definition of OHSS

Starting your fertility journey can be daunting, but it’s not helped when you hear about a new or scary sounding thing like Ovarian Hyperstimulation Syndrome. What is OHSS? It is a rare complication of receiving hormone injections that stimulate egg production. Ovarian blood vessels react abnormally to Human Chorionic Gonadotropin (HCG) and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen. That fluid will make the ovaries swell up and become painful. When you first hear about it, this can sound scary, but there are ways of managing and preventing this rare occurrence.

Mild vs. Severe Ovarian Hyperstimulation

The main difference between the different stages of classification comes from how bad the symptoms are and how badly it’s affecting you. On the mild side of the scale, you could get abdominal swelling, bloating, nausea, and tenderness around where your ovaries are and around your pelvis. If the condition is severe, you could experience excessive weight gain, severe nausea or vomiting, chest or leg pain- which could also be a sign of blood clots, and difficulty breathing because of fluid in your chest.

Causes and Risk Factors of OHSS

Hormonal Stimulation

Hormonal stimulation is the main cause of OHSS, caused by gonadotropins that stimulates the follicles to grow and the HCG shots that are used to kickstart the ovaries at the start of IVF treatment. The symptoms come from the body having an overreaction- it’s like a shock to your system. Usually, the condition occurs within a week of receiving an injection, and one of the easiest ways to monitor if you could be having this overreaction is to weigh yourself each day and monitor abdominal pain and if bloating occurs. If you’re worried, you can always go to your healthcare provider or fertility specialist.

IVF and Fertility Treatments

IVF injections that contain HCG hormones are the main cause of OHSS meaning that if you are injected with HCG, then there is the potential risk of developing it. However, there is only a 5% risk of developing it, and that number drops to 1% for severe cases. If you’re TTC and having problems this 5% risk should not deter you. If you are worried, talk to your healthcare provider for information and consider ways with them to negate the risks.

Age, PCOS, and Other Risk Factors

It is also possible that other risk factors such as having a large number of follicles, high levels of estrogen during IVF, having a “fresh” embryo (as opposed to a frozen embryo transfer) may affect your chances of developing OHSS. There is also some evidence that those who are under 30 years old or those who weigh less than average might be at a higher risk of developing the condition- but this is still under investigation. The final big risk factor is if you have PCOS. One of the ways to handle PCOS is to take PCOS supplements along the main treatment line. Supplements are designed to support your ovaries both in regular life and during IVF treatments. 

Mira’s PCOS Supplements have been a collaboration between experts and fertility doctors to help your body feel better inside and out. The powerful combination of vitamins and minerals is designed to restore ovulation and cycle regularity, balance hormones, reduce PCOS symptoms, boost your mood and energy, and more!

Symptoms and Complications of Ovarian Hyperstimulation

Common Symptoms

Common mild to moderate OHSS symptoms include bloating, mild weight gain, nausea, and abdominal pain. You’ll be glad to hear that most cases are in the mold to moderate category.

Severe Symptoms and Potential Health Risks

Severe symptoms include shortness of breath, decreased urination, blood clots, severe abdominal pain, severe nausea or vomiting, severe abdominal swelling, and excessive weight gain. These symptoms are not only unpleasant but could become a serious health concern if untreated.

Complications of Untreated OHSS

If left untreated, OHSS symptoms can worsen and require hospital visits. It can also cause kidney failure, ovarian torsion (twisting of the ovaries), cyst ruptures, organ failure, and pregnancy loss. The condition is life-threatening in its most severe form, but very few deaths have ever been reported, and with the right treatment, you can be free of the worst symptoms and move on to have a healthy pregnancy.

Diagnosing and Treating OHSS

How Ovarian Hyperstimulation Is Diagnosed

Your healthcare provider will perform a physical exam, checking your weight and measuring your waist to find signs of swelling. Whilst it might sound surprising, a pelvic exam isn’t recommended as excess pressure on the ovaries in this swollen state could lead them to burst! They may also do an ultrasound to detect fluids in your abdomen and inspect the size of your ovaries, a chest X-ray to see if there is fluid in your chest, and a blood test to measure your hormone levels.

Mild and Severe Treatment Options

Mild symptoms can be treated at home by avoiding strenuous physical activity, taking painkillers, drinking fluids with electrolytes in them, weighing yourself daily, and monitoring yourself for more severe signs of OHSS. You can also wear the less-than-fashionable high-compression socks to help reduce your chances of developing blood clots. For more severe cases, you might receive fluids through an IV, have a procedure to remove the fluid in your abdomen (paracentesis), have a blood thinner to decrease the risk of a clot, and take medication to reduce ovarian activity. Hospitalization may be required.

Medications Used in Treatment

OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using gonadotropin-releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS. To reduce the chances of getting blood clots, you may get Heparin injections and low-dose aspirin, along with compression socks. Painkillers and anti-sickness medications can be used to keep you comfortable. The final medicine used may be a dopamine agonist called Cabergoline, which has been shown to both prevent and reduce signs of OHSS. 

One way to keep an eye on these things is by using a hormone monitor such as the Mira Hormone Monitor. The FDA-listed monitor and Mira Fertility Max Wands can help track the three key fertility hormones, including LH. This is useful not only for monitoring your fertile days but also for monitoring your daily LH levels after you’ve had an IVF injection, which can be very helpful for healthcare providers when they are tracking your symptoms with you and helps you fell confident in understanding your unique body and fertility journey.

Prevention and When to Seek Help

Preventing OHSS During Fertility Treatments

Always discuss how to prevent OHSS with a healthcare professional. The first line of defense when looking into decreasing the chances of developing OHSS IVF is GnRH agonists as a trigger shot, as these reduce the risk of developing moderate-to-severe symptoms. Using frozen embryos over “fresh” ones, taking calcium infusions and dopamine agonists, and monitoring your ovaries with blood tests and ultrasounds are all additional ways to make sure that your ovaries are healthy during IVF.

Recognizing Warning Signs

Warning signs can include abdominal discomfort, abdominal swelling, and nausea. If you get any of these within a week of having your HCG injections, contact your healthcare provider so they can monitor your symptoms. 

If you are concerned about your fertility journey, then the Mira Hormone Health Clinic is for you. Mira’s data-driven fertility practitioners help you by providing individual whole-body TTC support, from beginning to end, so you can feel confident in the steps you are taking. There is no such thing as a bad question to ask them, and they will be there for you to understand your journey. Not only will they offer emotional support but also practical support with an action plan, hormone analysis, recommended lifestyle changes, a nutrition plan, and even practical strategies for optimizing men’s fertility.

Our hormone health practitioners do not diagnose or prescribe treatment. For medical advice, consult your healthcare provider.

How to Prevent OHSS Naturally

If you’re TTC using IVF, then there are some natural things you can. First of all, always try to drink ten to twelve glasses of water a day, this will help your body circulate nutrients and hormones in your bloodstream efficiently. Eating salty snacks and raw fruits and vegetables will ensure you have the right nutrients to help your body regulate itself, and fiber will help avoid constipation and keep down any bloating. Light activity is great for blood circulation, which helps stop blood clots from forming.  Most importantly, weigh yourself to monitor for rapid weight gain.

Frequently Asked Questions