Ovarian Hyperstimulation Syndrome - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Ovarian hyperstimulation syndrome (OHSS) is a complication associated with assisted reproduction procedures. It involves cyst-like enlargement of the ovaries and fluid leak into the cells. In addition, excessive injectable hormonal medications during fertility treatments like in-vitro fertilization (IVF) to stimulate the growth and development of eggs present in the ovaries may cause an exaggerated response in the body resulting in ovarian hyperstimulation syndrome (OHSS). In ovarian hyperstimulation syndrome (OHSS), the ovaries become swollen and painful leading to other complications.

What Is Ovarian Hyperstimulation Syndrome?

Ovarian hyperstimulation syndrome (OHSS) occurs due to in-vitro fertilization (IVF) procedures. During in-vitro fertilization (IVF) procedures, women take high doses of fertility medications to stimulate egg growth. In some women, ovarian hyperstimulation is a complication of fertility treatments, resulting in ovarian swellings and fluid leaking into the body. Ovarian hypersensitivity syndrome (OHSS) is more common in women undergoing fertility treatments with polycystic ovary syndrome (PCOS).

What Are the Causes of Ovarian Hyperstimulation Syndrome?

The exact cause of the incidence of ovarian hyperstimulation syndrome (OHSS) is not yet fully identified. However, the majority of women develop ovarian hyperstimulation syndrome (OHSS) after the use of high levels of glycoprotein hormones, such as human chorionic gonadotropin (hCG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) during fertility treatments. These hormones are ingested in women during in-vitro fertilization (IVF) procedures to enhance the maturation of the ovum and increase the chance of conception. During fertility treatments, high concentrations of human chorionic gonadotropin (hCG) are given to trigger the release of mature follicles and simultaneously release multiple mature eggs. However, sometimes ovarian blood vessels may react abnormally to this elevated human chorionic gonadotropin (hCG), resulting in fluid leaking from the blood vessels surrounding the ovaries and ovarian swelling. Therefore, injectable fertility hormones are the most important cause of ovarian hyperstimulation syndrome.

What Are the Symptoms of Ovarian Hyperstimulation Syndrome?

The symptoms of ovarian hyperstimulation syndrome depend on the severity of the condition. Symptoms may begin within a week after the use of injectable medications, but sometimes it takes more than two weeks for the symptoms to appear. The symptoms associated with ovarian hyperstimulation syndrome can be mild, moderate, and severe. It includes:

Mild Symptoms:

• Nausea.

• Abdominal bloating.

• Diarrhea.

• Feeling of fullness.

• Weight gain.

• Vomiting.

Moderate Symptoms:

• Excessive weight gain.

• Severe diarrhea.

• Dark urine.

• Increased abdominal circumference.

• Excessive thirst.

• Dry skin and hair.

• Decreased urine output.

• Severe vomiting.

Severe Symptoms:

• Shortness of breath.

• Severe abdominal pain.

• Persistent severe vomiting.

• Decreased urination.

• Kidney failure.

• Fullness above the waist.

• Chest and calf pains.

• Abdominal distension.

• Blood clots.

• Pulmonary embolism.

• Pleural effusion.

• Pericardial effusion.

• Atelectasis.

• Hypotension.

• Electrolyte imbalance.

What Are the Risk Factors Associated With Ovarian Hyperstimulation Syndrome?

Several factors can increase the risk of developing ovarian hyperstimulation syndrome in women. They are:

• Low body weight.

• Previous history of ovarian hyperstimulation syndrome.

• Polycystic ovary syndrome (PCOS).

• High levels of estrogen during in-vitro fertilization (IVF) stimulation.

• Ingestion of high human chorionic gonadotropin (hCG) during the in-vitro fertilization (IVF) cycle.

• Presence of a large number of follicles.

• Young age (below 35).

• Low body mass index (BMI).

How Can We Diagnose Ovarian Hyperstimulation Syndrome?

Diagnosis of ovarian hyperstimulation syndrome (OHSS) can be made based on various diagnostic tests. It includes the following.

• Physical Examination - A physical examination consists of checking weight, waist size, and bloating signs to diagnose swelling symptoms.

• Blood Test includes evaluating hormonal levels and other blood tests to diagnose impaired kidney function that may occur due to ovarian hyperstimulation syndrome.

• Ultrasound - An ultrasound helps to detect the size of the ovaries, the presence of free fluid in the abdomen, and swollen ovaries.

• Chest X-ray - It helps to evaluate the presence of fluid in the chest.

What Are the Treatment Options for Ovarian Hyperstimulation Syndrome?

Treatment procedures for ovarian hyperstimulation syndrome (OHSS) depend on the severity of the condition. Treatment involves the management of symptoms and measures to reduce complications.

Based on the severity of symptoms, the treatments can be the following.

Mild to Moderate Cases - Mild ovarian hyperstimulation usually resolves on its own. In case of moderate symptoms, the treatment includes:

• Frequent physical examinations.

• Increased intake of fluids.

• Excess abdominal fluid drainage.

• Monitoring of weight to check for changes.

• Blood tests to evaluate electrolyte imbalance and dehydration.

• Use of Acetaminophen to relieve pain.

• Avoid alcohol and caffeine.

• Reduced activities and rest.

Severe Cases - In cases of severe ovarian hyperstimulation syndrome (OHSS), the patient needs emergency medical management. It includes:

• Adjusting hormone dose.

• Intravenous fluid administration.

• Medications to decrease ovarian activity.

• Use of drugs like Cabergoline to reduce the symptoms.

• Intensive care for lung and liver complications.

• Surgery to manage ruptured ovarian cyst.

• Use of anticoagulant agents to reduce the risk of blood clotting.

What Are the Complications of Ovarian Hyperstimulation Syndrome?

Severe ovarian hyperstimulation syndrome (OHSS) may cause life-threatening complications. It includes:

• Fluid collection in the chest.

• Acute kidney failure.

• Ovarian torsion.

• Large blood vessel clots.

• Sodium and potassium imbalance.

• Bleeding.

• Breathing problems.

• Miscarriage.

• Rarely, death.

How Can We Prevent Ovarian Hyperstimulation Syndrome?

The chances of developing ovarian hyperstimulation syndrome (OHSS) can be reduced by properly monitoring fertility medications and hormone levels during in-vitro fertilization (IVF) procedures. Other strategies that can be used to prevent ovarian hyperstimulation syndrome (OHSS) are the following.

• Use of lower doses of gonadotropin hormones.

• Use low-dose Aspirin, Quinogloide, Dopamine, Cabergoline, and calcium infusions to reduce the risk of ovarian hyperstimulation syndrome (OHSS).

• Use Metformin tablets in women with polycystic ovary syndrome (PCOS) to prevent the chances of hyperstimulation.

• Use of alternative medications like Gn-RH agonists (Lupron) instead of human chorionic gonadotropin (hCG) trigger shots.

Conclusion:

Ovarian hyperstimulation syndrome (OHSS) is a rare complication of fertility treatment procedures. Ingestion of high doses of glycoprotein hormones like human chorionic gonadotropin (hCG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) during fertility treatments may cause an abnormal response in the body leading to ovarian swelling and pain. In severe cases, it may cause other liver, lung, and kidney complications.