What is Ovarian Hyperstimulation Syndrome (OHSS)?

One of the main risks in an IVF or egg donation cycle is developing a condition called Ovarian Hyperstimulation Syndrome or OHSS. Women with lots and lots of follicles and high estradiol levels during the cycle are most at risk. Early onset OHSS (the type that egg donors are at risk for) typically sets in 1-5 days after retrieval. Late onset is caused by rising HCG levels during pregnancy so isn’t applicable to egg donors (another great reason to abstain until after you get your post-donation period).

 

Symptoms may include:

• Fluid retention
• Rapid weight gain/abdominal distention
• Dizziness
• Nausea/vomiting
• Diarrhea
• Decreased urine output
• Abdominal pain/tenderness in ovaries
• Shortness of breath

 

OHSS is typically classified into severity categories- mild, moderate, severe and critical. Mild will typically resolve on its own and is uncomfortable but not very dangerous (but needs to be monitored). Moderate to severe will sometimes require fluid to be drained from the abdomen (very similar to retrieval a needle is passed through the vaginal wall with ultrasound guidance and the free fluid is drained providing relief from the pressure- it’s not as bad as I thought!) Severe to critical will require hospitalization, but the very serious type is rare.

 

A clinic can do many things to help prevent OHSS which may include some or all:

• Several different medications can be given starting at trigger or just after retrieval to help control hormone levels
• Lowering stimulating medications during the cycle
• Changing the trigger type from HCG to an agonist (not possible in all cycles as it depends on which medications are used during the cycle)

 

A donor can do a couple things to help deal with OHSS symptoms if they are mild to moderate

• Increasing protein intake during the last half of the cycle
• Increasing salt intake a lot (I like to dump salt right into my Gatorade- it tastes better than you think).
• Informing your clinic of any symptoms you’re unsure of
• Monitoring your weight and stomach girth following retrieval

 

Usually, symptoms of mild to moderate will resolve within a week or so following retrieval and everything should normalize with a period. If you’re ever unsure if your symptoms are normal or need treatment it never hurts to contact your clinic!