Welcome to our discussion on Ovarian Hyperstimulation Syndrome (OHSS). At MOM IVF, we are dedicated to providing high-quality, effective, and transparent fertility treatments, ensuring that
every step of your journey towards parenthood is guided by expertise, knowledge, and experience.
Ovarian Hyperstimulation Syndrome, or OHSS, is a condition that can occur during fertility treatments, especially in women undergoing in vitro fertilization (IVF) or other assisted
reproductive technologies. It's essential to understand that during this process, sometimes the ovaries can become swollen and painful, causing discomfort.
At MOM IVF, we are committed to creating a safe and inclusive space where you can access expert knowledge, connect with a supportive community, and find the resources you need to make
informed decisions about your family's future. We believe that every person deserves the opportunity to embrace the joys of parenthood, and we are dedicated to helping you achieve your
dreams.
So, let's dive into understanding what OHSS is, how it can be managed, and how we at MOM IVF are devoted to your well-being throughout your fertility journey.
Overview of Ovarian Hyperstimulation Syndrome (OHSS):
Ovarian Hyperstimulation Syndrome (OHSS) is a condition that can happen when women undergo fertility treatments like in vitro fertilization (IVF). It's important to understand that OHSS
can vary in severity, and it's divided into several grades:
Grade 1 - Grade 4:
When OHSS is mild to moderate, it means the symptoms are not too severe. Patients might experience some discomfort, but it's usually manageable, and there's little risk to the patient's
health.
Grade 5 - Grade 6:
When OHSS is severe, it can be life-threatening and needs immediate medical attention. This means the symptoms are very serious and can be dangerous to the patient's health.
Understanding the different grades of OHSS is important because it helps doctors and patients know how serious the condition is.
It helps to determine the best course of action to keep patients safe and healthy. If someone is experiencing severe symptoms of OHSS, they should seek medical help right away.
Pathophysiology:
The pathophysiology of OHSS is not entirely understood. Different factors have been proposed by various authors:
- Ovarian enlargement with significant stromal edema and multiple hemorrhagic follicular and theca luteal cysts result in extravasation of fluid into the peritoneal cavity (Rizk and
colleagues).
- Enhanced capillary permeability, leading to acute body fluid shifts resulting in ascites and pleural effusion.
- Increased production of prostaglandins, histamine, and the activation of the renin-angiotensin enzyme system within the follicles.
Prevention of Ovarian Hyperstimulation Syndrome (OHSS):
Prevention is crucial as there is no definitive treatment for OHSS. It involves the identification of patients at risk and the prediction of OHSS development. The following strategies can
help in preventing OHSS:
At-Risk Patients:
- Patients with Polycystic Ovary Syndrome (PCOS)
- Thin patients
- Young patients (< 35 years)
- History of OHSS in the previous cycle
- GnRH Agonist Protocol
Ultrasound Monitoring during Stimulation:
- Predicting OHSS involves monitoring the number, size, and pattern of distribution of follicles.
Prediction:
- Combined ultrasound and endocrine monitoring of follicular development help in predicting OHSS during ovarian stimulation.
- Endocrine Monitoring: Plasma Estradiol (E2) when elevated, is found to be the best predictor of hyperstimulation.
Cryopreservation of Embryos and subsequent replacement:
- By cryopreserving and postponing embryo transfer, the risk of OHSS is drastically reduced.
Correction of Circulatory and Electrolyte Imbalance:
- Strict monitoring of electrolytes and hematocrit values and correction of electrolyte imbalance and giving plasma expanders reduce the progression and complications of OHSS.
Intravenous Albumin:
- Prophylactic IV administration of 25% albumin at the time of oocyte retrieval is recommended by some authors to reduce OHSS.
Follicular Aspiration:
- Meticulous follicular aspiration has shown to reduce corpus luteum progesterone production but not found to prevent OHSS in ART cycles.
Laparoscopic Ovarian Drilling / Wedge Resection:
- When done prior to ovarian stimulation, especially in patients with polycystic, bulky ovaries, it decreases the incidence of OHSS.
Luteal Phase Support with Progesterone:
- By avoiding the use of HCG and using only Progesterone for luteal phase support, the incidence of OHSS decreases.
Step-Up Protocol:
- Low dose step-up protocol using gonadotropins, especially recombinant FSH, is found to produce reasonable ovulation and pregnancies in PCOs patients with a history of OHSS.
Paracentesis:
- Aspiration of ascitic fluid either transvaginally or transabdominally under ultrasound guidance reduces the complications of OHSS.
VEGF Antagonist:
- Cabergoline - 0.5mg/day for 10 days has found to decrease the incidence of OHSS.
Conclusion:
Proper identification and monitoring of patients at risk are crucial in the prevention of Ovarian Hyperstimulation Syndrome (OHSS). By employing the right strategies, we can significantly
decrease the incidence and progress of OHSS.
At MOM IVF, our commitment to the well-being of our patients is unwavering, and we strive to provide the highest quality of care throughout the journey to parenthood.
Importance of Proper Identification and Monitoring of Patients at Risk:
Identifying patients at risk of OHSS and closely monitoring their progress during fertility treatments are essential steps. By recognizing risk factors such as Polycystic Ovary
Syndrome (PCOS), thinness, or a history of OHSS, we can take proactive measures to prevent OHSS from occurring or worsening.
Through techniques like ultrasound monitoring and endocrine tracking, we can predict and prevent OHSS, ensuring the safety and well-being of our patients.
Decreasing the Incidence and Progress of OHSS:
By implementing preventative measures, such as cryopreservation of embryos, correction of electrolyte imbalances, and careful follicular aspiration, we can decrease both the incidence and
the severity of OHSS.
Through these steps, we aim to minimize the risk of severe complications, ensuring a safer and more successful fertility treatment process.
Commitment of MOM IVF to the Well-being of Patients:
We are deeply committed to the well-being of our patients. We strive to provide high-quality, effective, and transparent fertility treatments, ensuring that every step of the journey towards
parenthood is guided by expertise, knowledge, and experience.
Our ultimate goal is to create a safe and inclusive space where patients can access expert knowledge, connect with a supportive community, and make informed decisions about their family's
future.
With our commitment and dedication, we aim to help our patients achieve their dreams of parenthood while ensuring their trust and well-being throughout the process.