# Severe OHSS after first cycle - high risk - do I go through with second cycle



## amrssmith (Jun 8, 2015)

I had my first IVF cycle in August. I have low AMH, not polycystic and had low dose stims - 115 and 125. 
38 eggs collected at EC and because of this clinic advised freeze all. 
Within 2 days I was admitted to hospital due to OHSS, I was in for a week and it took me about 3 months to fully recover. 

On seeing the consultant to prep for FET he explained there was another drug protocol which can avoid OHSS all together so I was re-assured that this wouldn't be a problem again

FET negative and saw (different) consultant yesterday who advised cannot guarantee not to get OHSS. And that I appear to be pretty unusual to have had such a bad case of OHSS given my profile. He said freeze all should have totally taken away all risk. 

He does not want to use a different protocol but rather try to minimise follicles (around 10) and abandon the cycle if going over this. therefore wants to scan every other day to check what's happening. 

I had the strongest sense yet yesterday of how opinions differ so much in IVF and it is far from an exact science. I feel really very uncertain about whether to go ahead as it seems my body does its own thing regardless what the norm might be and I just don't feel confident in the opinions as they seem to vary so much. 

has anyone been in a similar situation?


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## Hopefulshell (Mar 14, 2013)

Hi

Sorry to hear you suffered OHSS. It's horrible isn't it? It took me several weeks to recover too after getting 26 eggs on my first round. You had a collosal number of eggs collected so I completely understand how awful that must have made you feel afterwards  

After getting OHSS I was always nervous about getting it again so my clinic tried different ways to reduce it. The second cycle I was only on 75 gonal f (100 previous round) and they checked my oestrogen levels regularly during stims. They erred on the side of caution and got me to trigger earlier but downside was I got 9 eggs but didn't result in particularly good blasts. So third time it was a case of knowing that I needed more than 75 but 100 was too much. The answer was to follow an agonist cycle. This meant that I was on a higher dose of gonal f but triggered with buserilin rather than an HCG shot like Overtril. The result was that as soon as the trigger was administered the follicles stopped growing (with the HCG triggers I understand they continue to grow). I got 16 eggs on my third attempt and felt absolutely fine afterwards. Only downside was I had to take extra oestrogen to compensate for not having the HCG shot.

My clinic aim for an ideal yield of 10-15 eggs at ec. Having too many not only increases your risk of OHSS but also affects the quality too. I understand your apprehension as it was always at the back of my mind that it could happen again but I made my fears clear at subsequent follow ups so action was taken to try to reduce the risk. I am a classic case of high risk OHSS - pcos, petite and over 35 - yet my oestrogen levels were well within the normal range the first time so clinic had no reason to suspect OHSS would develop. As I'm sure you're aware pregnancy can significantly increase OHSS as the HCG rises sharply in the first few weeks. In hindsight I wish my clinic has suggested a freeze all but at the time their FET rates were quite a bit lower than fresh so they made a judgement call. 

It sounds like your dr is keen to prevent you developing it again and if he's only aiming for 10 that's a huge decrease in the risk for you. I'm sure they'll be monitoring you very closely and assuming put you on a lower stim dose to stop you over responding. It's all a bit of an unknown in the early cycles but once the Drs know how your specific body reacts they can make adjustments accordingly.

I hope your next round is a lot less uncomfortable and gives you the outcome you desire.

X


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## amrssmith (Jun 8, 2015)

Dear Hopefulshell

Thanks so much for your reply and sorry it has taken me
Such an age to respond to it. It was reassuring to hear the journey you had been on. 
It looks like you had a BFP in Jan and I hope this is all going well for you?

We decided to delay treatment not just because of the OHSS but because I developed another possibly hereditary condition which we want to try and understand better first.

Anyway thank you again I appreciate the thoughtfulness of your response.


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