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  • Writer's pictureDr. Karenne Fru, MD, PhD, Reproductive Endocrinologist

Ovarian Hyperstimulation Syndrome (OHSS) in IVF Treatment

Ovarian hyperstimulation syndrome (OHSS) poses a potential risk associated with hormonal medications used in IVF treatment. The purpose of these fertility hormones is to stimulate the recruitment and growth of multiple follicles containing eggs. However, in certain cases, the ovaries may over-respond, leading to the recruitment of more eggs than intended and triggering a range of side effects. OHSS affects only a small percentage of IVF patients and can manifest as mild to severe symptoms. Prior to commencing IVF treatment, it is crucial to comprehend these risks and learn strategies for their minimization.


What is Ovarian Hyperstimulation Syndrome (OHSS)?


OHSS may occur as a side effect in women receiving gonadotropin shots during the early stages of IVF treatment. While the objective is to stimulate egg production in the ovaries, excessive stimulation can sometimes arise. This causes the ovaries to swell and release fluid into the chest and abdominal regions.


As a result of this overstimulation, OHSS symptoms may include:

- Abdominal bloating

- Mild stomach pain

- Weight gain


In rarer instances, women may experience more severe symptoms, such as intense abdominal pain or swelling, rapid weight gain, decreased urination, shortness of breath, as well as nausea, vomiting, and diarrhea.


For mild cases of OHSS, management involves simple actions such as rest, elevating the feet, and maintaining hydration. Over-the-counter pain relievers can also help alleviate discomfort.


If any severe symptoms of OHSS are experienced, seeking medical attention is necessary. Healthcare providers will monitor these symptoms to detect any potential major complications, which may include blood clots, kidney failure, electrolyte imbalance, or significant fluid accumulation.


Risk Factors for OHSS


Certain risk factors contribute to an increased likelihood of experiencing OHSS during IVF treatment:


- Young age: Women below the age of 35 face a higher risk of OHSS.

- Low BMI: Research indicates that a low body mass index also elevates the chances of developing OHSS.

- PCOS: Women with polycystic ovary syndrome (PCOS) are considered at higher risk during IVF.

- Previous OHSS: A history of OHSS increases the likelihood of developing it again.


How common is OHSS among IVF patients?


Studies indicate that 3% to 6% of individuals undergoing IVF treatment experience OHSS. Individual odds depend on unique characteristics and the treatment protocols implemented by fertility specialists.


Minimizing the Risks of OHSS in IVF Treatment


Numerous controlled ovarian stimulation techniques exist to reduce the risk of OHSS. One approach involves reducing the dosage of hormonal medications. Additionally, instead of commonly used human chorionic gonadotropin (hCG) for ovulation triggering, many specialists now employ leuprolide, a GnRH agonist. Medications like cabergoline can also be prescribed to mitigate swelling and inflammation.

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