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Ovarian Hyperstimulation: Not Your Ovarian Average Cyst

Approximately 1-2% of all live births in the United States are as a result of assisted reproductive technologies (ART), which includes procedures such as fertility medication, artificial insemination, IVF and surrogacy. Pregnancies resulting from assisted reproduction are more complicated, with higher rates of ectopic, heterotopic and multifetal pregnancies, in addition to higher rates of abortions and premature deliveries. Higher rates of maternal disease such as preeclampsia, diabetes mellitus, bleeding, anemia are also present. Other complications include venous thromboembolism (VTE) as well as OHSS.

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 Why do in vitro fertilization cycles sometimes get cancelled?

IVF cycles can also be cancelled due to an excessive response from the ovaries, to the horomonal drugs used in stimlation. Being a high responder can, in the more serious cases, lead to Ovarian Hyperstimulation syndrome, OHSS. The extra estrogens as a result of overstimulation can cause the ovaries to grow excessively. Moreover, it can cause the follicular fluid to leak from the ovaries into the abdominal cavity, which can cause more serious side effects. Last but not least, OHSS increases the risk for the blood vessels to become “leaky”. This can compromise the renal and respiratory systems, cause liver damage, and alter the production of blood. In short, OHSS can become a life-threatening side effect in the worst cases.

Articles of Interest

High Doses of Hormones Faulted in Fertility Care

Two days after Debra Demidon underwent in vitro fertilization, she gained more than 30 pounds in fluid and suddenly was struggling to breathe. Doctors diagnosed severe ovarian hyperstimulation syndrome (OHSS), a complication seen in some women who undergo fertility treatment. It landed Ms. Demidon in the hospital for five days; doctors ultimately drained 6.5 liters of fluid from her body. She missed three weeks of work, and by the time it was over, she and her husband had spent all of their savings.

Increase in IVF complications raises concerns over use of fertility drugs

In the past decade the numbers of OHSS cases have been steadily falling as clinics have shifted towards milder treatments, but the latest figures suggest a reversal of this trend.

Surviving OHSS

As I write this post, it is the day after my second egg retrieval (although I’ve scheduled it for a few days time). The first was a disaster and probably one of the hardest times of my life because I had moderate OHSS and then a failed pregnancy.

A new effective method in the treatment of severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a recognized complication of ovulation induction, occurring in 1-10% of IVF and embryo transfer cycles. While mild OHSS is of no clinical relevance, severe OHSS is a life threatening complication. However, the efficacy of prevalent treatments appeared to be limited. We developed a continuous autotransfusion system with an ultrafiltration instrument for reinfusion the protein of concentrated ascites for the treatment of severe OHSS.

IVF: Some Doctors Suggest a Milder, Cheaper Form for Some Women

With the number of babies born through in vitro fertilization at an all-time high, some doctors are trying an alternative that potentially could be less expensive and less taxing on a woman's body. Some fertility clinics are offering a gentler version of IVF that uses fewer, milder drugs and requires less frequent medical visits.

Managing ovarian hyperstimulation syndrome (OHSS): can kisseptin reduce the risk?

Kisseptin is a new medication that can also be used to stimulate the ovaries. It is a peptide (protein) that can stimulate the body to produce gonadotrophin-releasing hormone (GnRH). It is classified as a GnRH agonist (GnRHa). Kisseptin has a much shorter duration of action and causes a lower level of stimulation.

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Its occurrence is dependent on the administration of human chorionic gonadotrophin (hCG).

Ovarian hyperstimulation syndrome – it's time to reverse the trend

Severe ovarian hyperstimulation syndrome (OHSS) is a serious and potentially fatal condition caused by overstimulation of the ovaries by drugs during IVF treatment. It is preventable with the modern management of IVF cycles, and the incidence of the condition should therefore be falling precipitously to almost zero – as it is in many countries.

Ovarian Hyperstimulation: Not Your Ovarian Average Cyst

The complications of OHSS include VTE, ovarian torsion, intravascular depletion, life threatening fluid shifts and significant end organ damage, all of which should be addressed and ruled out on presentation to the emergency department.

Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal.

Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline

Because OHSS is the most serious consequence of controlled ovarian stimulation, every attempt should be made to identify patients who are at highest risk.

What Is OHSS and How Do You Avoid It?

OHSS is a serious condition. Women may experience a broad spectrum of signs and symptoms ranging from mild, moderate to severe forms. When this condition develops, most women will experience enlarged ovaries (see ultrasound image), mild forms with abdominal bloating, discomfort, shortness of breath and mild weight gain—this primarily water weight. However some women may develop a severe form...

Resources

PCOS Awareness Association

Ovarian hyperstimulation syndrome (OHSS) causes swelling of the ovaries with leaking of fluid within the body. PCOS and the use of fertility treatments to stimulate the ovaries can increase the risk for OHSS. It affects about 10% of women who undergo traditional IVF. When it occurs, OHSS is usually temporary and resolves within 1-2 weeks. Mild symptoms include bloating, discomfort/pain, and weight gain. Severe cases of OHSS occur rarely and can lead to hospitalization due to serious symptoms and complications including severe pain, swelling in the abdomen, breathing problems, decreased urination, blood clots, and kidney failure.

Life in the Fastlane

Increased capillary permeability -> hypovolaemia + haemoconcentration -> oedema, ascites, pleural effusions, pericardial effusion, hypovolaemia, shock, renal failure...