IVF Is Not Always Smooth Sailing

In vitro fertilization (IVF) has gone from a rare, unattainable option to accessible for many American adults. The procedure has proven to be an option for those who struggle with infertility. IVF is also popular among women, same-sex couples, or individuals looking to delay family planning. This innovative form of assisted reproductive technology (ART) creates viable embryos in a fertility clinic. While effective, the process is not always perfect and is open to complications. Ovarian hyperstimulation syndrome (OHSS) is the most common side effect that can delay or disrupt IVF. Despite the challenges, OHSS can be addressed, transforming the outcome of IVF.


Could you have overstimulated your ovaries?

Through extracting multiple eggs to combine with sperm, fertility clinics can then transfer 1 or more embryos into a woman's uterus to kickstart pregnancy. IVF requires the use of fertility medications to develop multiple follicles needed for extraction. Medications like gonadotropins and gonadotropin-releasing hormone (GnRH) agonists stimulate the ovaries for egg production. However, the ovaries can overreact to these drugs, leading to OHSS. This condition causes the ovaries to swell and leak fluid into the abdomen. In severe cases, OHSS can limit IVF cycles, leading to delays or failures.

Causes and symptoms of OHSS

OHSS varies from patient to patient and can range from mild to severe. Mild symptoms are nausea, bloating, and abdominal pain. Moderate to severe forms of OHSS include excess weight gain, severe abdominal pain, and even difficulty breathing. These cases must be addressed immediately to prevent severe complications. IVF requires a delicate balance of injectable fertility medications, so the primary cause is excess external hormones. Along with injectable fertility drugs, other risk factors include younger reproductive age and conditions like polycystic ovarian syndrome (PCOS). Identifying and treating OHSS is vital in proceeding with IVF while ensuring the woman's safety.

Effective treatment options

Different treatment options vary based on the severity of the condition. Doctors recommend noticing the signs of OHSS and seeking fast treatment. Mild cases can benefit from pain and nausea medication. Other effective techniques include drinking electrolyte-rich fluids, getting sufficient rest, and monitoring rapid weight changes. Once Mild cases are well managed, IVF can proceed. Moderate to severe cases may need additional treatment and monitoring. A doctor may recommend hospitalization so the patient can receive intravenous (IV) fluids. The medical team will provide medication to counteract the hormones impacting the ovaries. Further monitoring and treatment, such as fluid drainage, may be necessary. Severe cases will delay or even prevent future IVF cycles with the woman's own follicles.

Can you prevent OHSS?

Mild cases of OHSS can last several days and can resolve if the woman fails to get pregnant during the IVF cycle. Moderate to severe cases can persist, with some continuing for several weeks, especially if the woman gets pregnant. With the right strategy, OHSS is preventable. The best option is to work closely with the fertility team and pharmacist. If there is a concern, the fertility team can review and adjust medication to limit overstimulation of the ovaries. Women with past cases of OHSS can work on lifestyle changes to lower the risk of developing the condition. Addressing underlying conditions like PCOS before IVF can also help with preventing OHSS. Should the initial signs of OHSS occur, focus on rest, limit vigorous activity, and immediately communicate with the fertility team.

Don't let overstimulation prevent pregnancy

OHSS can be a challenging, painful, and emotionally taxing complication of IVF. The issue can cause physical and emotional distress, increase medical costs, and delay a successful pregnancy. Studies show that the risk of OHSS ranges from 3-6%, going as high as 31% in some cases. Despite these risks, fertility teams anticipate this complication and can recommend treatments based on the condition's severity. Addressing OHSS, however, depends on patients quickly reporting symptoms and openly communicating with the doctors. By quickly and effectively addressing OHSS, IVF cycles can continue and even be successful without issue.