Ovarian hyperstimulation syndrome


The painful swelling of the ovaries, in response to exogenous hormone therapy is called ovarian hyperstimulation syndrome (OHSS). It is commonly found in women who are trying to get pregnant through fertility treatments,  with help of healthcare experts like Best Gynecologist in Lahore

Read on to know more about ovarian hyperstimulation syndrome:

What are the symptoms of Ovarian hyperstimulation syndrome?

Ovarian hyperstimulation syndrome symptoms begin almost a week after the injectable hormones due to high levels of hCG hormone for the stimulation of egg production.  The symptoms range from mild to severe. 

Mild Ovarian hyperstimulation syndrome

The mild form of Ovarian hyperstimulation syndrome is a consequence of injectable fertility drugs. If pregnancy does not occur, the symptoms go away in about a week. However, if pregnancy does occur, there is worsening of Ovarian hyperstimulation syndrome with prolongation of discomfort, lasting several weeks. 

The classification of mild ovarian hyperstimulation syndrome is: 

Grade 1: There is abdominal pain, distension and discomfort. Mild Ovarian hyperstimulation syndrome begins with abdominal bloating and increased weight size, and tenderness in the region. 

Grade 2: with worsening of Ovarian hyperstimulation syndrome, there is nausea, vomiting and diarrhea with enlargement of the ovaries by 5 to 12 cm.

Moderate Ovarian hyperstimulation syndrome

Grade 3: symptoms of mild Ovarian hyperstimulation syndrome along with evidence of ascites on the ultrasound. 

Ascites is fluid in the abdomen which is detectable on the ultrasound. Moderate OHSS presents with worsening symptoms of mild Ovarian hyperstimulation syndrome and overlapping ascites. 

Severe Ovarian hyperstimulation syndrome

When ovarian hyperstimulation reaches severe form, there is weight gain of more than 2.2 pounds over a period of 24 hours. Additionally, there is effect on the kidneys, with decreased urination, shortness of breath due to hydrothorax and tight abdomen. 

Grade 4: symptoms of moderate ovarian hyperstimulation syndrome, clinical evidence of ascites, with breathing difficulties and hydrothorax. 

Grade 5: all the aforementioned symptoms, with increase in blood volume, blood viscosity, increased hemoconcentration and coagulation abnormalities. In this grade, the renal blood supply is diminished which impacts renal function as well. 

What are the treatment options for Ovarian hyperstimulation syndrome?

The exact cause of ovarian hyperstimulation syndrome is not exactly understood. However, if anyone undergoing fertility treatments experiences the aforementioned symptoms, they should reach out to their healthcare provider. 

Mild cases of the syndrome usually resolve on their own. For mild pain, over-the-counter pain killers like acetaminophen help to relieve discomfort. During this time, sexual activity must be avoided as it can intensify the pain and any ovarian cyst present to rupture. Physical activities must be kept light and no high-impact activities must be performed for similar reason. 

For severe cases, treatment is commenced, and it’s aimed at decreasing the ovarian activity and avoiding further deterioration of the condition. 

Mild to moderate Ovarian hyperstimulation syndrome

Treatment includes regular assessment of the patient, with measurement of the abdomen, and daily weight measurement to check for any drastic change in condition. It is recommended for the patient to increase their fluid intake so the kidneys are not affected. To keep a check on the kidney function, urine production is measured over 24 hours. Blood tests are done to check on the electrolyte imbalance, dehydration and other problems. Anticoagulants are taken daily to prevent blood clots from forming. In case ascites develop, aspiration of the fluid using a needle is done to drain the excess fluid from the abdomen. 

Severe Ovarian hyperstimulation syndrome

Severe Ovarian hyperstimulation syndrome warrants hospital admission. In-patients with OHSS are then monitored carefully by professionals like Best Gynecologist in Karachi for worsening of condition. Aggressive treatment with IV fluids is started immediately, followed by drugs like cabergoline and letrozole (antagonist of gonadotropin-releasing hormone) to suppress the ovarian activity. If complications like ruptured ovarian cyst occurs, surgery may become necessary. Alternatively, there can be lung or liver complications, requiring specialist care.