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Ovarian hyperstimulation after puncture

Assisted reproductive medicine gives many couples the chance to become parents. Due to the fact that this method of treatment is quite young and for many couples is unexplored, there are many myths about its course and consequences. For example, many women do not want to enter the protocol for fear of developing ovarian hyperstimulation syndrome. To date, ART have reached the level when the effect on the woman’s body is minimal and this pathology develops in a small number of cases. Let’s take a closer look at OHSS.

What is OHSS?

Ovarian hyperstimulation syndrome or OHSS is a complication of superovulation used as part of an IVF service protocol or other fertility treatments. Medication stimulation can cause an uncontrolled ovarian response. Normally, a woman matures one follicle per cycle. This number can be increased by ovarian stimulation. In rare cases, with a multifollicular response, OHSS may develop. Let’s take a closer look at its course.

Ovarian hyperstimulation: symptoms and forms

Symptoms of the syndrome appear within 3-10 days after the administration of chorionic gonadotropin – hCG. The superovulation drug increases the concentration of hormones, making the vascular walls more permeable. As a result, the liquid, saturated with protein compounds, can begin to penetrate into the body cavities and accumulate there. There are different stages of the severity of the syndrome. With mild to moderate ascitic fluid is in the abdominal region, with severe effusion is present in the pleural cavity and pericardial sac.

As a result, the blood content in the vessels decreases, it begins to thicken. As a result, the risk of blood clots is seriously increased. The body’s systems cease to receive the necessary blood supply.

Stimulation of superovulation involves different protocols of infertility therapy: IVF, artificial insemination, etc. At the same time, natural cases of the development of hyperstimulation are known without the use of special drugs.

Symptoms vary depending on the severity of the syndrome.

  1. Lightweight. The ovaries increase up to 10 cm. The woman feels discomfort in the lower abdomen: heaviness, tone, weak pain syndrome. A slight increase in the waist is possible.
  2. Moderate. The ovaries increase by more than 10 cm. The abdominal distension is more noticeable. Pain in the internal genital area becomes more noticeable. The volume of the abdomen and the total body weight increase. The patient begins to develop gastrointestinal disorders: nausea, vomiting, diarrhea. Ultrasound records the state of ascites.
  3. Heavy. The ovaries are more than 12 cm. The abdomen is greatly enlarged by ascites. Fluid in the lungs and pericardium makes it difficult to breathe, worsens the heartbeat. The woman feels weak, dry mouth, dizziness, suffers from severe abdominal pain. A decrease in the frequency of urination and oliguria are also recorded. Pain in the legs may occur.

If a mild degree involves outpatient treatment, then hospitalization is mandatory for moderate or severe. In such cases, drip therapy is needed to prevent dehydration, and preventive measures to prevent blood clots. In the most severe cases, the patient is transferred to intensive care.

There are two forms of OHSS.

  1. Early. Formed within a week after the puncture.
  2. Late. Complication after puncture appears only after 7-10 days.

OHSS and pregnancy are linked. The late form develops when the ovum begins to produce its hCG. Then the condition of the expectant mother worsens. If pregnancy does not occur, the early form of the syndrome goes away about 3 days before menstruation.

Prevention of OHSS

The reproductive specialist chooses a protocol that maximally excludes the risks of OHSS during IVF (reducing the dosage of gonadotropin, choosing certain drugs to stimulate and trigger ovulation).

Refusal of fresh embryo transfer, in favor of transfer in the subsequent menstrual cycle, “freeze all” strategy (IVF cycle segmentation).

Medical correction of the patient’s condition in the IVF protocol and immediately after the puncture.

The risk of serious complications is only 1%. At the same time, the doctor, knowing the main risk factors, can predict the development of this syndrome with some certainty.

The prevention of the syndrome also depends on the actions of the expectant mother. A woman needs to strictly adhere to the prescriptions and recommendations of a reproductive physician, monitor her condition, inform her doctor about her health.

To reduce the risk of complications, it is recommended to drink plenty of water without gas – 3-4 liters per day and protein food with the rejection of foods that cause gas formation. Also, for some time after the puncture, you should observe sexual rest and avoid serious physical exertion.

Saenko Alla
Saenko Alla
Reproductionist, obstetrician-gynecologist of the first category, doctor of medical sciences. n.

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