What is OHSS?

OHSS can occur in women who have had injections of gonadotropins or follicle stimulating hormones (FSH) to stimulate their ovaries.  If large numbers of follicles develop, the high hormone levels coming out of these hyperstimulate ovaries, combined with the increased size of the ovaries, may cause a series of unpleasant and potentially serious side effects, known as Ovarian Hyperstimulation Syndome (OHSS).  The more follicles that develop, the higher the risk of OHSS.
When OHSS develops, the hormones and chemicals that are released by the ovary and other organs affect the blood vessels, causing fluid to leak from the blood stream into the abdominal and/or lug cavities (causing abdominal distention and/or shortness of breath) and the tissues beneath the skin.  There is less urine output, and the balance of compounds like sodium and potassium within the body become quite disturbed.  The blood may also become more concentrated and thicker, increasing the risk of blood clots.

All women who undergo ovarian stimulation with FSH during IVF treatment experience enlargement of their ovaries and a complex change in their hormone imbalance.  Many will have minor symptoms of OHSS (since we the ovaries have intentionally been overstimulated), but these can be treated at home with rest and adequate fluid intake.  Immediate medical attention is required should symptoms persist or worsen.  The majority of patients get better within 5-15 days.  Pregnancy may prolong or exaggerate these symptoms and it may take up to 10 weeks for the symptoms to resolve if you are pregnant.  If your period starts, you will likely begin to feel better.
Signs and Symptoms

• Abdominal bloating, feeling of fullness
• Pelvic bloating, feeling of fullness
• General malaise (feeling "under the weather")
• Nausea, vomiting, diarrhea
• Increasing thirst
• Decreasing urination, darker urine
• Weight gain (greater than 2 lbs a day)
• Chest pain, shortness of breath, calf pain (severe OHSS)

What to Do

• Reduce activities (no heavy lifting, straining or exercise)
• Drink 32-64 ounces of Gatorade daily
• Check your weight every morning when you get up
• Monitor how much you drink each day
• Monitor the number of times you urinate each day and the color of the urine
• Monitor abdominal circumference (measure at the belly button) each day

When to Contact Your Doctor

• Severe continuing lower abdominal/pelvic pain which is causing sleep disturbance and needing recurrent pain medications
• Abdominal distention (swelling, bloating) causing increasing discomfort and/or shortness of breath
• Weight gain of 2 lbs or more in one day
• Decreasing urine output
• Persistent nausea, vomiting and/or diarrhea
• Chest pain, shortness of breath, difficulty breathing
• Swelling of one leg, calf tenderness

Information collected from the University of Utah Reproductive Care Center