How to Manage Ovarian Hyperstimulation Syndrome (OHSS)

Ovarian hyperstimulation syndrome usually affects women undergoing hormone medication injectable in order to stimulate the growth of eggs in the ovaries. Women undergoing in vitro fertilization, intrauterine insemination or ovulation induction usually goes through such syndrome.

Excessive hormone injection in the body leads to ovarian hyperstimulation syndrome (OHSS). The ovaries become swollen and often painful due to this. Some women may develop severe OHSS that brings the following consequences:

  1. Vomiting

  2. Mild to moderate abdominal pain

  3. Diarrhea

  4. Shortness of breath

  5. Rapid weight gain

  6. Abdominal bloating

  7. Vomiting

  8. Increased waist size

  9. Nausea

  10. Tenderness in the area of ovaries

In case the woman is on oral fertility medications like clomiphene (Clomid, Serophene), she is supposed to suffer less from the OHSS syndrome. There can be occasional nausea or vomiting tendency in women undergoing medications taken by mouth.

Symptoms of Ovarian Hyperstimulation Syndrome

The symptoms of ovarian hyperstimulation syndrome often are usually felt within first 10 days of hormone injections. The injections are given to stimulate ovulation. The symptoms range from mild to severe. At times it may worsen in severity or improve over time. The patient usually feels nausea all the day or at specific times of the day. This might be accompanied by vomiting or vomiting tendency. The patient feels discomfort in breathing normally and suffers from abdominal pain. Increased period of such abnormalities makes her gain weight. Such weight gain is rapid and usually increases the waist size. In all such occasions, the patients are advised to ask for medical attention without any delay. Quick consultation reduces a lot of risks and discomfort.

Mild to Moderate OHSS

The symptoms of mild to moderate ovarian hyperstimulation syndrome include the followings:

  1. Slight to medium pain in the abdomen

  2. Abdominal bloating

  3. Sudden weight increase

  4. Nausea

  5. Vomiting tendency throughout the day and more after meals

  6. Loose motions and indigestion

These symptoms tend to go away after 7 days of the fertile drug injections. However, the same symptoms may persist as the pregnancy develops out of such fertility treatment. Doctors prescribe other medications or therapies to bring all such symptoms under control. There are varied medical therapies to soothe the patient from all these irritation, soreness and pangs. Right medical attention relaxes the patient immediately and calms her pain. Doctors can very well anticipate the discomforts that the patient can go through due to the hormonal changes during this time. They are prepared for their course of medications and a wide range of complementary therapies to ease the patient from the ongoing suffering and irritation.

Severe OHSS

The symptoms related to severe ovarian hyperstimulation syndrome are:

  1. Fast weight gain in a small span of time

  2. Extreme abdominal pain

  3. Extreme nausea and vomiting tendency

  4. Blood clots in lower limbs

  5. Reduced urination

  6. Enlarged abdomen

  7. Shortness of breath

  8. Tightness in the abdomen

Consulting a Doctor

Consult your doctor if you are experiencing severe symptoms of OHSS during your fertility treatment. Ovarian hyperstimulation syndrome often causes extreme nausea or abdominal pain that might get beyond toleration after a certain point. It is better to consult with the doctor before reaching any severe condition. Immediately Contact your doctor in case of breathing problems or pain in the lower limbs. These are urgent situations and need prompt medical attention. Delay in medical attention unnecessarily irritates the patient. The situation can become severe due to such unwanted delay in medical attention.

Causes of Ovarian Hyperstimulation Syndrome

The causes of ovarian hyperstimulation syndrome are yet not fully known. Higher levels of human chorionic gonadotropin (HCG) hormone are introduced into the female body during IVF treatment that plays a role in this. Ovarian blood vessels are not acquainted with the HCG hormones and often react abnormally. This is when the fluid begins to leak. Such leakage swells the ovaries. At times the fluids move into the abdomen that raises extreme pain.

HCG hormones are injected to enhance the development of mature follicles. Such injections cause discomforts in the body within a week of its execution. The situation may even worsen once the pregnancy is achieved in this treatment cycle.

Factors of Risk

Factors that increase risks of OHSS are:

  1. Polycystic ovary syndrome

  2. Large number of follicles

  3. Women below the age of 30

  4. Poor body weight

  5. Increasing level of estradiol (estrogen) in the women before injection HCG shots

  6. History of OHSS in the previous IVF cycles

  7. At rare occasions, OHSS affects women who may not have many risks of it.

Complications Related To OHSS

Almost 2 to 3% women undergoing IVF treatment suffer from extreme effects of OHSS. It can even become life-threatening after a certain point in time. The complications related to are:

  1. Accumulation of fluid in the abdomen or chest

  2. Disturbances in the Electrolyte levels such as sodium or potassium

  3. Large vessel Blood clots in the lower limbs

  4. Kidney failure

  5. Ovarian torsion or twist in the ovary

  6. Rupture of ovarian cyst leading to serious bleeding

  7. Troubles in Breathing

  8. Miscarriage or termination of pregnancy

Preventive Measures

In order To decrease the possibilities of ovarian hyperstimulation syndrome development, doctors usually plan individual treatment plans for particular fertility medications. They first monitor the treatment cycle by frequent ultrasounds and ascertain the development of follicles. Regular blood tests are conducted to track the hormone levels in the body. Frequent doctor visit for check-ups is very necessary during this time to keep a track of the changes the body is going through. This helps in controlling the extremity of the syndrome and comforts the woman at the required time.

Strategies to Help Prevent OHSS

Women undergoing IVF treatment simultaneously remain active in their personal lives. They continue with their jobs and other duties during this period. Hormonal changes in their bodies due to certain oral medicines and injections, however, have effects on their bodies and they tend to divert from the normal life. In case they fall sick due to such medication, their normal routine hampers and hinders their lives. This is the reason doctors set different strategies to prevent the discomforts arising due to OHSS. Some of them are:

Changes in Medication

Doctors usually prescribe the minimum dose of gonadotropins to trigger ovulation. This helps them adjust better to the drug and not feels much of a sudden discomfort.


For patients who have high levels of estrogen or a large number of developed follicles, the doctor usually restricts on the injectable medications and maintains a gap in giving the HCG injection. This strategy is known as coasting and is an effective option to control severe OHSS.

Alternates of HCG

Medications like Gn-RH agonists, such as leuprolide (Lupron) are used as an alternative to HCG hormone injection to prevent or limit OHSS.

Freezing Embryos

All the mature and immature follicles of Women undergoing IVF are removed from their ovaries to control the chance of OHSS in them. The Mature follicles collected out of them are fertilized and frozen. The ovaries are allowed some time to rest and prepare itself for the IVF treatment. The treatment cycle is resumed once the body is ready.