Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production.
Causes, incidence, and risk factors
Normally, a woman produces one egg per month. Some women who have trouble getting pregnant may be given medicines to help them make more eggs.
If these medicines stimulate the ovaries too much, the ovaries can become very swollen. Fluid can leak into the belly and chest area. This is called ovarian hyperstimulation syndrome (OHSS). OHSS occurs only after the eggs are released from the ovary (ovulation).
You may be more likely to get OHSS if:
Your doctor gives you a shot of human chorionic gonadotropin (hCG)
You get more than one dose of hCG after ovulation
You become pregnant during this cycle
OHSS rarely occurs in women who only take fertility drugs by mouth.
OHSS affects up to 1 in 10 women who go through in vitro fertilization.
Other risk factors for OHSS include:
Age younger than 35
Very high estrogen level during fertility treatments
Mild cases of OHSS usually don't need to be treated. You can ease your discomfort by doing the following:
Get plenty of rest with your legs raised. This helps your body release the fluid. However, light activity every now and then is better than complete bed rest, unless your doctor tells you otherwise.
Drink at least 10 - 12 glasses of fluid a day (especially drinks that contain electrolytes).
Avoid alcohol or caffeinated beverages (such as colas or coffee).
Avoid intense exercise and sexual intercourse, which can cause ovarian discomfort and may cause ovarian cysts to rupture or leak or cause the ovaries to twist and cut off blood flow (ovarian torsion).
Take an over-the-counter pain reliever such as acetaminophen (Tylenol).
You should weigh yourself each day to make sure you are not putting on too much weight (5 or more pounds a day).
In the rare case that you develop severe OHSS, you will probably need to go to a hospital. The health care providers there will give you fluids through a vein (intravenous fluids), remove fluids that have collected in your body, and monitor your condition.
Most mild cases of OHSS will go away on their own after menstruation starts. If you have a more severe case, it can take several days for symptoms to improve.
If you become pregnant during OHSS, the symptoms may get worse and can take weeks to go away.
In rare cases, OHSS can lead to life-threatening complications, including:
Severe electrolyte imbalance
Severe fluid build-up in the abdomen or chest
Calling your health care provider
Call your health care provider if you experience any of the following symptoms:
Excessive weight gain (more than 5 pounds a day)
Nausea so intense that you can't keep food or liquids down
Severe abdominal pain
Shortness of breath
If you are receiving injections of fertility medicines, your doctor will monitor you carefully with blood tests and pelvic ultrasounds to make sure that your ovaries aren't over-responding.
If your estrogen level rises very high or very quickly while taking fertility injections, your risk for OHSS is increased. You may need to take a lower dose of the medicines or temporarily stop treatment.
Some women may be given a protein solution called albumin to reduce the chances of OHSS.
Schorge JO, Schaffer JI, Halvorson LM, et al. Treatment of the infertile couple. In: Cunningham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY: McGraw-Hill; 2010:chap 20.
Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.