Ovarian Hyper-Stimulation Syndrome

I want to talk about possible complications of egg retrievals.  There are obvious ones like bleeding and infection since they sticking a large needle in your abdomen; but, there is also another very serious complication called Ovarian Hyperstimulation Syndrome (OHSS).  When follicles are stimulated, the capillaries in the ovaries leak releasing a very small amount of fluid naturally. Because only one-two follicles are usually stimulated, the body is able to handle the fluid that eventually gets reabsorbed back into the tissues.  When the number of follicles that are stimulated increases with medication, so does the amount of fluid making it harder for the body to handle.

Unfortunately, the egg retrieval does not relieve the problem because the hormones are still at high levels, causing further leakage.  And if there is a Fresh Embryo Transfer right after retrieval, the continuing high HCG levels can cause continuing leakage prolonging the time period of OHSS.

OHSS can be mild and cause bloating, weight gain, abdominal pain and nausea; however it can be as severe as a weight gain of 30-40 pounds over a week, severe pain, decrease urine output (and darkening of urine), shortness of breath, blood clots in legs, electrolyte imbalances and bloating to the point of the abdomen being tight and rigid.  Death can even occur if not treated quickly enough.

I was at risk for OHSS because of my PCOS and had mild symptoms of it.  The doctor who performed my first IVF was very worried that I might develop more severe symptoms and was somewhat conservative on my medication dosing because of it.  He also stated that it was somewhat of a blessing I only had 1 ovary since it decreased my risk of severe OHSS.

One of the ways they helped me prevent severe OHSS symptoms was to have me consume large amount of protein over the course of several days after the egg retrieval.  The normal woman consumes around 40-50 grams of protein – I am probably a little less than average consuming 20-40 grams. The doctors told me to increase that to a minimum of 90 grams per day which I managed thanks to protein shakes – many, many, MANY protein shakes and much prodding and nagging from Andrew.  The increase in protein helps draw the free fluid in the abdomen into the blood vessels (then to the kidneys where it is urinated out). It was pretty amazing to watch my urine output (I am nurse, ok? I find all of this fascinating) go from decreasing right after the egg retrieval to  peeing every 1-2 hours after a couple of days of protein shakes.

I have heard some horror stories about people ending up in the ICU. I even had a teenage patient once who had an egg retrieval done before chemotherapy and she experienced it.  Even when it’s mild, it’s super uncomfortable and all the hormone changes happening in the body don’t help with the coping.

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