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07/09/2024
Ovarian Hyperstimulation
Syndrome (OHSS).
BY RN SITI NOOR HAFIZAH SALWANI
TMC2536
IVF OPD
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CONTENT :

 What is Ovarian Hyperstimulation Syndrome (OHSS).

 Symptoms of Ovarian Hyperstimulation Syndrome (OHSS).
 Causes of Ovarian Hyperstimulation Syndrome (OHSS).
 Risk Factors for Ovarian Hyperstimulation Syndrome (OHSS).
 Classification of Ovarian Hyperstimulation Syndrome (OHSS).
 Complications of Ovarian Hyperstimulation Syndrome (OHSS).
 Diagnosis of Ovarian Hyperstimulation Syndrome (OHSS).
 Treatment of Ovarian Hyperstimulation Syndrome (OHSS).
 Ovarian Hyperstimulation Syndrome (OHSS) Do's and Don'ts.
 Conclusion.
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What is Ovarian Hyperstimulation Syndrome
(OHSS)?

 Ovarian Hyperstimulation Syndrome (OHSS) is a medical condition that can occur in

women undergoing fertility treatments, particularly those involving the use of medications
to stimulate the ovaries to produce multiple eggs.

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Symptoms of Ovarian Hyperstimulation
Syndrome (OHSS).
Mild.
 Mild Abdominal Pain: Tenderness near the ovaries.
 Bloating and Abdominal Discomfort: Feeling of fullness or mild pain.
 Ovarian size usually <8cm.

Moderate Symptoms.
 Moderate Abdominal Pain: Tenderness near the ovaries.
 Nausea, Possibly with Vomiting: Feeling sick to the stomach.
 Diarrhea: Can also occur.
 Slight Enlargement of the Ovaries: Detected by a healthcare provider. Ultrasound evidence of ascites.
 Ovarian size 8cm to 12cm.

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CONT.
Severe Symptoms.
 Clinical ascites (usually hydrothorax).
 Oliguria : Urinating less frequently or in smaller amounts.
 Haemoconcentration Hematocrit >45%.
 Hypoproteinemia.
 Ovarian size >12mm
Critical symptoms.
 Tense ascites or large hydrothorax.
 Hematocrit >55%
 White cell count >25 000/ml.
 Oligo/anuria
 Thromboembolism.
 Acute respiratory distress syndrome - Shortness of Breath: Difficulty breathing.
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Classification of Ovarian Hyperstimulation 6
Syndrome (OHSS).

 Early OHSS – presenting within 10 days after the administration of hCG

reflects excessive ovarian response to gonadotropin stimulation.
 Late OHSS – presenting 10 or more days after the administration of hCG
reflects endogenous hCG stimulation from an early pregnancy.

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Causes of Ovarian Hyperstimulation
Syndrome (OHSS).

 Hormonal Medications.
 Ovarian Sensitivity.
 Polycystic Ovary Syndrome (PCOS).
 High Doses of Stimulation.
 Pregnancy.
 Genetic Factors.
 Other Medical Conditions.

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 In most cases, OHSS develops because of the hormone HCG (human chorionic
gonadotropin) stimulating your ovaries. Your ovaries typically produce just one egg at a
time, but hormone treatments stimulate your ovaries to grow a lot of eggs at one time.
People undergoing fertility treatments often receive a “trigger shot” of HCG to help the
eggs mature before the egg retrieval process of IVF. When people develop a lot of
potential eggs, the ovaries can respond excessively to this medication, and they can
develop OHSS.

 In people with OHSS, drugs used in fertility treatments cause the blood vessels
surrounding their ovaries to leak fluid. Sometimes this fluid moves into your belly and
causes symptoms like swelling and pain.

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Risk Factors for Ovarian Hyperstimulation
Syndrome (OHSS).

Some factors increase the risk of developing OHSS, including:

 High dose of stimulating hormones.
 Polycystic Ovary Syndrome (PCOS).
 Young age.
 Low body weight.
 Previous episodes of OHSS.
 High ovarian reserve.

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Complications of Ovarian Hyperstimulation
Syndrome (OHSS).

Severe OHSS can lead to serious complications, such as:

 Ovarian Rupture.
 Blood Clots.
 Kidney Damage.
 Electrolyte Imbalance.
 Breathing Issues.
 Death (rare).

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Diagnosis of Ovarian Hyperstimulation
Syndrome (OHSS).

Diagnosing OHSS involves a combination of medical history, physical examination, and

laboratory tests:
 Medical History and Examination - A provider checks your weight and measures the size
of your waist to look for signs of swelling. A pelvic exam isn’t recommended because
your ovaries are swollen and may burst under direct pressure.
 Ultrasound - Detects free fluid in your belly (abdomen) the abdomen and the size of your
ovaries.
 Blood Tests - Measures your hormone levels for signs of OHSS.
 Monitoring of symptoms and treatment response.
 Chest X-ray: Looks for fluid in your chest.

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Treatment of Ovarian Hyperstimulation
Syndrome (OHSS).
The treatment for OHSS varies depending on how severe the condition is. Treatment aims to
manage symptoms and avoid complications. Mild cases tend to go away within a week or
two. However, if you get pregnant that cycle, your symptoms could last much longer.

For mild to moderate cases of OHSS, treatment usually involves:

 Avoiding vigorous physical activity.
 Drinking electrolyte-rich fluid like Gatorade® or Propel®.
 Using acetaminophen to relieve symptoms.
 Weighing yourself daily.
 Monitoring yourself for any severe symptoms.

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Severe cases of OHSS often require hospitalization. Treatment of severe OHSS may include:

 Receiving intravenous (directly into the vein) fluids.

 Undergoing paracentesis (a procedure to remove fluid from your belly).
 Taking medicines to ease symptoms or reduce activity in your ovaries.
 A blood thinner to help decrease the risk of a blood clot.
 Sometimes hospitalization is required for supportive care and close monitoring until
symptoms improve.

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Ovarian Hyperstimulation Syndrome (OHSS)
Do's and Don'ts:

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Prevention of Ovarian Hyperstimulation
Syndrome (OHSS).
How do you prevent ovarian hyperstimulation syndrome (OHHS)?
 Some cases of OHSS can’t be prevented. However, your healthcare provider will know if
you’re at risk based on your health history and bloodwork. During fertility treatments,
your healthcare provider may monitor your ovaries regularly using blood tests (to check
hormone levels) and ultrasounds (to look at how many follicles are developing) to reduce
your risk of OHSS.
Ways your team can help prevent OHSS (or minimize symptoms) include:
 Reducing or adjusting your fertility medication dosage.
 Avoiding a “trigger shot” of HCG during treatment.
 Changing the type of fertility medication.
 Freezing your embryos and delaying their embryo transfer until the ovaries return to
normal.
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Is it normal to feel sick after egg collection?

 Yes, feeling sick after egg collection is a normal side effect of IVF. Common symptoms
include bloating, spotting and feeling full.

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What can I expect if I have this condition?

 OHSS is temporary. The condition typically goes away within two weeks. Even severe
cases have a positive outlook when you receive prompt treatment. If the fertility treatment
is successful and you become pregnant, having OHSS doesn’t pose any risk to the
pregnancy.

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Conclusion.

 Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF treatment.

Most cases are mild and resolve within one to two weeks. Talk to your healthcare provider
about your risk for OHSS. They can answer any questions you have. If, at any point
during IVF treatment, you feel symptoms of OHSS, contact your healthcare provider as
soon as possible.

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THANK YOU
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