Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is a problem that is sometimes seen in women who take fertility medicines to stimulate egg production.

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Causes

Normally, a woman releases 1 egg per month. Women who have a hard time getting pregnant may be given medicines to help them release multiple eggs.

The ovaries can become very swollen if the medicines stimulate the ovaries too much. Fluid can leak into the belly and chest. This is called OHSS. It happens only after the eggs are released from the ovary (ovulation).

OHSS rarely happens in women who only take fertility medicines by mouth.

OHSS happens in 3 to 6 out of 100 of women who go through in vitro fertilization (IVF).

You may be more likely to get OHSS if you:

Get a shot of human chorionic gonadotropin (hCG)
Become pregnant during the cycle
Are younger than age 35
Have a very high estrogen level during fertility treatments
Have polycystic ovarian syndrome (PCOS)

Onset

Early hyperstimulation often starts 1 to 3 days after retrieval. It peaks in 7 days and tends to get better by 10 to 14 days.

Hyperstimulation can start more than 7 days after retrieval. This often happens with pregnancy.

Signs

Signs of OHSS can range from mild to severe. Most women have mild signs, such as:

Bloating
Mild pain in the belly

In rare cases, women can have more serious signs, such as:

Rapid weight gain (5 pounds overnight)
Severe pain or swelling in the belly
Less peeing than normal
Feeling short of breath
Nausea, vomiting, or diarrhea

Exams and Tests

If you have more serious signs your care team will check you for OHSS. They will weigh you. You may have other tests done also. Tests that may be done are:

Abdominal or vaginal ultrasound
Chest x-ray
Blood work
Tests to measure urine (pee) output

Treatment

Mild cases often do not need to be treated. Weigh yourself each morning to be sure you are not gaining too much weight. You should not gain more than 5 pounds overnight.

In the rare case you get severe OHSS, you may need to go to a hospital. You will get fluids through a vein (intravenous fluids). They may also remove fluid that has collected in your body and watch your condition.

Ease your discomfort by:

Getting plenty of rest with your legs raised. This helps your body release the fluid. Do some light activity unless your doctor tells you different.
Drink 1 to 1.5 liters of fluids with electrolytes, such as Gatorade®, G2®, or Propel®.
Do not drink alcohol or caffeinated drinks, such as colas or coffee.
Do not do intense exercise or have sexual intercourse. These can cause ovarian discomfort. They may also cause ovarian cysts to rupture or leak. It can also cause the ovaries to twist and cut off blood flow (ovarian torsion).
Take an over-the-counter pain reliever, such as acetaminophen (Tylenol®).

Most mild cases go away on their own after menstruation starts. It can take many days to feel better if you have a more severe case. You may get worse and take weeks to feel better if you become pregnant during OHSS.

Risks

In rare cases, OHSS can lead to life-threatening problems, such as:

Blood clots
Kidney failure
Severe electrolyte imbalance
Severe fluid buildup in the belly or chest

Call your care team if you:

Pee less than normal
Gain more than 5 pounds overnight
Have nausea or vomiting (you cannot keep food or liquids down)
Have severe abdominal pain
Feel short of breath
Have a severe headache, feel dizzy or weak, have visual changes, or have calf tenderness

Hours to Call

Call your clinic during business hours. After hours (nights, weekends, and holidays), call the Hospital Operator at 319-356-1616 and ask to speak with the on-call gynecology resident.