Ovarian Hyperstimulation (OHSS) is a condition that can occur during menstrual cycles in which the ovaries are stimulated with medication. While cycles associated with high serum estrogen levels and large numbers of follicles carry a greater risk of developing OHSS, there are no absolute cutoffs and the exact cause of this condition is unknown.

In its most mild form, symptoms of OHSS include weight gain with abdominal bloating and discomfort. When more severe, there are also symptoms of:

• Shortness of breath and dizziness
• Rapid pulse
• Excessive weight gain
• Fluid accumulation in the abdomen
• Low blood pressure
• Decreased urine output
• Nausea occasionally with vomiting

On rare occasions, an enlarged ovarian cyst may rupture. While this can cause severe abdominal pain, it is usually self-limited and soon subsides. Even more rarely, the enlarged ovary may twist, causing excruciating pain. Although either of these conditions can lead to surgery and removal of the ovary, they are extremely rare. Roughly 10% of patients have mild OHSS and less than 1% of patients need to be admitted to the hospital, with surgery being needed even less commonly.

PREVENTION:

Because hyperstimulation happens only rarely when ovulation does not occur, other than withholding your hCG injection there is no guaranteed way to prevent OHSS. Although there are medications which may decrease the risk of hyperstimulation, there is no other accepted way (other than not giving the hCG injection) to prevent it. However, your doctors may adjust the dose of your medication in an attempt to decrease your risk for ovarian hyperstimulation.

TREATMENT:

If after receiving hCG, you develop any of the symptoms described above, you should notify the office. Although it is very uncommon, severe OHSS may require hospitalization. As such, it is very important that if you experience severe abdominal pain, especially if combined with vomiting or significant weight gain, that you contact the office so that you can be evaluated. While there is no specific treatment, below are listed some instructions to follow:

• Weigh yourself daily and alert the office if you gain more than 5 pounds
• Drink fluids according to your degree of thirst. If you cannot drink because of pain, nausea or repetitive vomitting, notify the office
• Avoid anything that might injure your ovaries (strenuous activity, exercise, intercourse, etc.). While vaginal probe ultrasounds are safe, pelvic examinations must be avoided
• Avoid tight fitting clothing. Tylenol and heating pads are safe to use
• Rest. Do not minimize OHSS and stay home from work taking it as easy as you can
• If you have any questions or concerns, call the office. If you are out of town and experience severe pain, go to the nearest emergency room. However, alert them to the fact that your ovaries are enlarged and, as such, pelvic exams should be avoided. Please ask any physician you see in an outside emergency room to contact our office prior to the initiation of any therapeutic intervention.

DURATION:

Symptoms of Ovarian Hyperstimulation usually resolve spontaneously with the onset of the next period, or shortly thereafter. If you are pregnant, the symptoms may worsen somewhat and last approximately 2 to 3 weeks.

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