IVF is a finer treatment option for childless couples but it needs a better understanding before opting for it.It has lots of Myths and Facts associated with it.Patients often have fear of side effects of medicines used to stimulate their ovaries to grow their eggs.
One such side effect is Accumulation of fluid in the body what we call medically as OHSS (Ovarian Hyperstimulation Syndrome) but it's not a uniform feature in all IVF patients.OHSS has a tendency to happen in a selective group of patients with high-risk factors which can be predicted and prevented.So via this write up our focus is on to single out such predisposing factors so that appropriate measures can be taken on time. It's not only duty of a treating doctor but a patient also need to be aware that landing up with sudden surprises and bitter experiences.
Why is it a concern?
- A marked increase in patient population in infertility clinics
- Changing lifestyle
- Advances in the field of ART – act as a Double-edged sword with pros and cons
- ART technology – is more patient-friendly, with less complication with cost still a limiting factor with no 100% guarantee
What is OHSS?
It is a Life-threatening medical (Iatrogenic, drug-induced) complication and unique to the treatment of infertility with an acute onset but reversible in nature with enlarged ovaries with cysts and fluid accumulation in body cavities to a variable extent depending on gravity and grade
What are types of OHSS?
Who all have a risk to develop OHSS?
- Young age, Low body mass index
- Polycystic ovary syndrome (PCOS)
- Higher doses of exogenous gonadotropins
- High Estradiol levels with a rapid rise
- Previous episodes of OHSS
- Multiple developing follicles(20-25)
- Exogenous hCG for superovulation/ luteal support
- Multiple Pregnancy
- Serum factors increasing the permeability of blood vessels
How can it be prevented?
- Primary or Secondary prevention
- Cycle cancellation Coasting or controlled drift
- GnRH analogues GnRH antagonists
- Recombinant LH
- Insulin sensitizers - Metformin
- IV albumin 20%
- ACE inhibitors + Angiotensin II receptor blocker
- USG Guided Follicular Aspiration
- Elective Embryo Cryo Preservation and Transfer in the subsequent cycle
- In vitro maturation of oocytes (IVM)
How will my body behave when I Have OHSS?
Most frequent symptoms and signs are:
- Distention of lower abdomen
- Nausea and vomiting
- Dyspnea and respiratory distress
- Quick weight gain
- Ovaries enlarged up to >12 cm
What to do If I have pregnancy and OHSS Both?
The course generally unpredictable.That depends on how many pregnancies and response of body and period of onset of OHSS
Can It be 100% Prevented /Eliminated?
No, but deterioration can be prevented.There is definitely aim to have OHSS free treatment
How to manage OHSS?
- Supportive therapy
- Maintenance of intravascular volume
- Prevention/treatment of a complication
- Counselling - Signs and symptoms of OHSS
- Evaluate the baseline status with - complete history - complete general and systemic examination (pelvic examination contraindicated as ovaries are fragile, can rupture or undergo torsion)
- Limit activity
- Weigh daily
- Monitor intake (1liter/day) and output
- Daily follow up
- Report if symptoms worsen or weight gain> 2lb/day
- Admission needed in the hospital as per clinical status of the patient