# OHSS



## judy620 (Dec 8, 2004)

hello

this is a article i came across in the net regarding ohss. anyone knows if the article is correct about the treatment.

[size=10pt][size=10pt]What is ovarian hyperstimulation syndrome (OHSS)?

The single most serious complication that an IVF patient faces, apart from multiple pregnancy, is the risk of becoming seriously ill after being stimulated with injectable fertility medications. This condition is known as Ovarian Hyperstimulation Syndrome (OHSS) and reports suggest that 1 to 2% of patients who receive these medications may develop signs of hemoconcentration, weight gain, severe abdominal distension, ovarian enlargement and in severe cases even renal failure. The exact cause of this syndrome is still incompletely understood, although it is well known that the administration of Human Chorionic Gonadotropin (HCG) is the precipitating event which sets in motion the symptoms mentioned above and that OHSS is made worse by pregnancy! When there are more than 20 follicles developing and the estradiol level rises above 4000 pg/ml then there is a risk of moderate OHSS and with more than 30 follicles and estradiol greater than 6000 pg/ml there is an 80% chance of developing severe OHSS. In the past, the only way of avoiding severe OHSS was to withhold the administration of the HCG and cancel the IVF cycle.

The patients most likely to develop OHSS are patients with menstrual cycles longer than 30 days or patients with irregular ovulation and menstruation. Age is also a factor, but OHSS can occur in patients over 40 years if more than 20 follicles are produced. We can therefore predict which patients are most likely to develop hyperstimulation based on menstrual history and we can also identify early during stimulation, which patients are producing more than 20 follicles. "Prolonged Coasting" is a simple procedure whereby the fertility medication is stopped at a very specific time, in patients that are at risk for OHSS. The correct time to discontinue the fertility medication is when approximately 30% of the follicles have reached 15 or 16 millimeters in diameter. The estradiol levels should be followed daily thereafter and they will continue to rise and when the estradiol level falls below 3000 pg/ml it is safe to administer HCG and proceed to egg retrieval.

Embryo quality after coasting is better than the quality seen in non-coasted patients and the pregnancy outcome in patients who require coasting is excellent. It is important to restrict fluid intake to one liter of a sports drink like Gatorade per day for approximately 10 days after the egg retrieval.

If you think that you are a high responder or have menstrual cycles that are irregular, make sure that your doctor is familiar with "prolonged coasting" it may prevent a cancelled cycle and also avoid causing ovarian hyperstimulation syndrome

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## Pilchardcat (Feb 1, 2003)

Hi Judy

Yes it is although not everyone who gets ohss after embro transfer will be pregnant. Pregnancy makes ohss worse if you are at risk of it anyway as it makes the oestrogen rise in your body again.

Do you think you have it??  Amanda x


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## Happy Mummy (Sep 22, 2006)

Hi girls, 

This is a good article that explain OHSS even better than I what I read so far. This is not the only problem of IVF as unfortunately I am realising as the adenomyosis I suffer from and usually only gives me unexplained intermenstrual bleeding an heavy period, has given me since EC and drugs given during that procedure, bowel inflamation and rectal pain, and god knows how long this is going to go for. Now I have to be reffered to a gastroentorologist and then a gynecolo. to try and ease effects. I saw an osteopath yesterday who finds me very swollen in that area. I hurts when I seat although not as much as used to and I still have painful trapped wind, and all this is not made clear before ivf , only side effects really mentionned is OHSS, and trapped wind, or abdominal discomfort.  I did not overstimulate ( 8 FOllies), so no OHSS for me.
As for the poor ladies who do suffer OHSS , not all docs know or want to do prolonged coasting and it results in cancelled cycle indeed and all those follies waisted. When we know a woman has a set number of follies all her life , if the patient is an older patient ( around 40) it can really alter and egg reserve . 

So always push for testing and checking if you think that you have any unual discomfort, even if doc says it is normal with the drugs ( and they sometimes do).
Take care,
Future Mummy


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## Tinx (Sep 2, 2005)

I have been told that I need to drink at least 3 litres of water a day after egg collection to help flush out your body and to help reduce bloating. I had 24 follies and 22 eggs. ( my hospital cut of point for transfer was 25 eggs)  My hormone levels were high but my consultant said that they were not too high so we have gone ahead and had 2 embyos transferred. I feel huge and uncomfy but my e/c was a week ago and I am slowly beginning to shrink, but I still look awful! I was not told about the bloating, constipation or pain after IVF by anyone, I was just told to expect cramp like pains!!! They must be kidding!! Its been excruciating, but I think that`s due to having so many eggs. I hope it will all be worth it!! I am very aware of HSS and am keeping an eye on thing!!

Tinx


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## judy620 (Dec 8, 2004)

sorry for not being on the board due to blood tests   
i have around 20 follicles on my right and 10 on my left. my estrodial levels b4 are 4027. the dr asked me to do one again today so today it was 3800. he refused to give my hcg inj till my levels dropped to 3500 by tmrw or he will cancel the procedure. it will such a waste of pain and trouble i went thru for the jabbing 

amanda- the dr does think i am potentially at risk to get it. 

future mummy and tinx - hang on girls and all the best


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## Ycoll002 (Sep 10, 2006)

Hi Judy,

I had around 24 measurable follies at my last scan on Sunday, and estradiol is around 4000 and they've said I'm at risk of OHSS too. I've had the HCG injection last night and am to have EC tomorrow. The Doc says all embryos will need to be frozen if I get more than 20 eggs.

Really worried about it now, and they've said EC will be more painful than usual because of the amount of eggs, but I'm actually in quite a lot of discomfort (read agony!) already!!

Not really sure what to think anymore!!!!

Fingers crossed for you that it all works out  

Yvonne xx


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## judy620 (Dec 8, 2004)

hi yvonne
hope you get good quality eggs.you will be in my prayers tmrw.
all the best and relax.     for you.


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