OHSS is the most serious complication caused by iatrogenic drug use in in vitro fertilization and infertility (insemination) treatment. Due to the medications used, excessive growth in the ovaries and fluid leakage out of the veins occur. Complaints and symptoms in OHSS begin to appear approximately 10 days after you start using medication. OHSS can be mild or severe.
Findings seen in Mild and Moderate OHSS:
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Nausea and vomiting
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Mild and moderate abdominal pain
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Diarrhea
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Abdominal bloating and increase in abdominal circumference
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Tenderness in the ovarian area
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Rapid weight gain (3 kg and more)
Findings seen in severe OHSS:
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Rapid weight gain, 15-20 kg in 5-10 days
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Severe abdominal pain
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Severe nausea and vomiting
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Decrease in urine output
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Shortness of breath
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Advanced abdominal distension and tension
Ovarian Hyperstimulation Syndrome (OHSS) Cause :
Although the exact cause is not known exactly, high amounts of hCG hormone causes fluid leakage from the veins to the body cavities. This fluid causes swelling of the ovaries and abdomen.
OHSS begins approximately 1 week after the use of hCG hormone (crack shot), which is used in high amounts for egg maturation during treatment. If pregnancy occurs during treatment, OHSS will get worse. OHSS is much more common in injection treatments than pills.
OHSS Risk Factors:
Factors that will increase the risk of OHSS:
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PCO (polycystic ovary syndrome)
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Having a large number of follicles (multicystic ovary)
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Under 30 years of age
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Low weight
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High and rapid increase in E2 level
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Having had OHSS before
There is a possibility of developing OHSS in women who have no risk factors.
OHSS Complications:
Approximately 1-2 of the women who receive ovulation induction treatment have OHSS. Severe OHSS is very serious and can result in death.
Complications:
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Ascites (in the abdomen and sometimes in the chest)
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Hemoconcentration, blood clotting, especially in leg veins
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Hypovolemia
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Electrolyte imbalance (Sodium, potassium and others)
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Kidney failure
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Ovarian torsion
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Serious bleeding as a result of rupture of ovarian cysts
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Breathing problems
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Pregnancy losses or termination of pregnancy for therapeutic purposes
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Death is rare
Protection from OHSS:
Doses of medications should be adjusted individually to reduce the possibility of developing OHSS. The number and size of follicles should be closely monitored and the hormone level should be controlled with ultrasound.
To prevent OHSS:
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Doses of medications should be adjusted and changed: Drugs used in ovulation induction. should be at the lowest possible level. Use of metformin may reduce the risk in patients with PCO.
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Coasting: If there are too many growing follicles and the E2 level is too high, the injections can be stopped for a few days before hCG is given.
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Avoidance of hCG: GnRH agonist (such as leuprolide) can be used instead of hCG for maturation.
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Embryo Freezing: OHSS The best way to avoid. During in vitro fertilization treatment, all follicles (mature and immature) are removed from the ovaries. Healthy embryos formed by mature follicular fertilization are frozen in groups and transferred after the ovaries become normal.
Treatment in OHSS:
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If OHSS has developed despite all efforts, treatment should be performed with close follow-up.
Albumin: It increases the intravascular oncotic pressure so that the fluid that escapes out of the vessel returns to the vessel.
Cabargoline (dostinex) reduces vascular permeability in the early period.
Heparin is started to prevent intravascular thrombosis.
Admission to the hospital and fluid and electrolyte balance are performed.
In cases where severe swelling and resulting shortness of breath develop, some acid fluid is taken to provide relief to the patient.
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