Ovarian HyperStimulation Syndrome (OHSS) – Symptoms & Causes

Ovarian Hyperstimulation Syndrome is a bodily response to the excess hormones given to the body after which the ovaries swell and become painful. Excess hormones are given to those women whose ovaries need stimulation to produce eggs while preparing them for an IVF procedure. Less frequently, Ovarian Hyperstimulation Syndrome occurs when certain fertility related medicines are taken orally. In cases where the symptoms are mild, the condition may improve on its own without any treatment, whereas in cases of women with severe symptoms, they may need additional treatment and hospitalization.

What are the symptoms of Ovarian Hyperstimulation Syndrome?

As said, symptoms of Ovarian Hyperstimulation Syndrome can be mild or severe and varies from person to person. Onset of symptoms may happen from a week or two after the injectable hormones are given.

Mild symptoms include:

1. Mild abdominal pain
2. Abdominal bloating and increase in waist size (with little weight gain)
3. Nausea
4. Vomiting
5. Diarrhoea
6. Tenderness in the area where ovaries are present

Severe symptoms of OHSS:

1. Rapid weight gain in a day
2. Severe abdominal pain due to excessive swelling of ovaries
3. Persistent Nausea and Vomiting
4. Blood clots
5. Shortness of breath
6. Enlarged abdomen

If pregnancy occurs when the woman is having mild symptoms of Ovarian HyperStimulation Syndrome, they may worsen and last longer. If you have taken any hormone injection to stimulate ovaries (and to conceive or for IVF in future), and have any of the above mentioned symptoms, mild or severe, please contact your gynaecologist immediately. It is better to report even the mild symptoms so that your doctor can keep tab on your health.

Causes of Ovarian HyperStimulation Syndrome

In short, OHSS is caused due to the injections (hormone based) given to stimulate the ovaries. When the HCG (Human Chorionic Gonadotropin) levels increase in the body, the blood vessels in the ovaries leak fluid into the ovaries resulting in swelling. Sometimes, large amount of fluids can move into the abdomen causing the bloat and pain.

HCG also acts as a trigger for the mature follicle to release egg. If fertilization occurs in such a situation, the symptoms may worsen requiring hospitalization.

1. Who are at risk of developing OHSS?

   In fact, women who are deemed to be at minimal risk of developing OHSS also see the symptoms of OHSS. However, following are the risk factors in women for developing OHSS:

   1. Women under 35 years of age.
   2. If estrogen levels increase before getting the HCG shot
   3. Low body weight
   4. Large number of follicles (follicles are sacks that release eggs in the ovaries).
   5. Women suffering from PCOS – Polycystic Ovary Syndrome.

What can severe symptoms of OHSS lead to (complications of OHSS)?

Severe symptoms if not attended to by your gynaecologist can be life threatening:

1. Accumulation of fluids in the ovaries and in the abdomen
2. Blood clots, especially in legs
3. Kidney failure
4. Ovarian Torsion (twisting of ovaries)
5. Rupture of cyst in the ovaries that can lead to internal bleeding
6. Severe breathing problems
7. Miscarriage (if pregnant)
8. Death (Rare)

How can you doctor prevent OHSS?

1. Low dosage of HCG – your doctor may start with the lowest dosage of HCG
2. Addition of other medication along with HCG to reduce the risk of OHSS
3. If your estrogen levels are very high, your doctor may take a break from giving you hormones that trigger ovulation. This is called Coasting.
4. Totally avoiding HCG
5. Removal of all follicles to reduce the risk of OHSS.

Diagnosis of OHSS is done starting with a physical examination and an imaging test. Blood test may also be done to look for signs of kidney failures.  Treatment of OHSS (usually in severe cases) may require hospitalization, putting the woman on IV fluids and giving medication to control the symptoms. If the HCG levels are very high, antagonist hormones for HCG may also be given to suppress activity of the ovaries.