Ovarian Hyperstimulation Syndrome

The medications used to stimulate your ovaries may cause side effects.  These side effects can range from mild to severe.  Excessive stimulation of the ovaries is called ovarian hyperstimulation.  This may require a hospital stay.  Be aware of body changes and contact your program nurse if you have any questions or concerns.  She will contact the physician if necessary.  You will usually have symptoms of mild hyperstimulation during your treatment cycle.  However, moderate and severe symptoms are less common and usually occur at lease several days after embryo transfer. 

 

signs and symptoms	why it happens	what to do
mild: You may experience   w abdominal bloating and feeling     of fullness w nausea w diarrhea w slight weight gain	This may be due to:   w ovaries are larger than normal,     tender, and fragile w high levels of estrogen in the blood stream may upset your digestive system and fluid balance causing bloating	Recommended treatment:   w avoid sexual intercourse  w do not have a vaginal (pelvic) exam     other than by a program physician w reduce activities, no heavy lifting straining, or exercise w drink clear fluids, flat coke, ginger ale or cranberry juice w if unable to drink for more than 24 hours, call your program nurse
moderate: You may also experience: w lower abdominal soreness w weight gain of greater than 2     lbs. per day (excessive weight gain) w increased abdominal    measurement causing clothes to feel too tight w vomiting and diarrhea w urine is darker and amount is     less w skin/hair feel dry w thirst	This may be due to:   w high levels of hormones in the     bloodstream upset the digestive system w fluid imbalance causes dehydration because body fluid collects in the abdomen and other tissues w this fluid collection causes severe bloating. w further ovarian enlargement	As above plus:   w call the program nurse or after hours the physician on call w you may need to be seen by a physician  who may do an ultrasound w do daily weights each morning w measure around your abdomen while     lying flat (just above the belly button)     before getting out of bed w you may need blood tests w hospitalization may be necessary
severe: You may also experience:    w fullness/bloating up above the belly button w shortness of breath w urination has reduced, stopped, and become darker w calf pains and chest pains w marked abdominal bloating or distention w lower abdominal pain	This may be due to:   w extremely large ovaries w fluid collects in the lungs and/or     abdominal cavity as well as in     tissues w the risk of abdominal blood     clotting increases	As above plus:   w call the program nurse or after hours the physician on call as soon as possible w you may need to be assessed at the     hospital w hospitalization may be necessary w may be necessary to remove excess fluid from the abdomen with a needle w blood thinners and IVF fluids may be    required

 

If your period starts, you will likely begin to feel better. Pregnancy may prolong or exacerbate these side effects.  It may take up to 10 weeks for the symptoms to resolve.  REMEMBER:  The fact sheet is only a guide and not intended as a substitute for medical care.

 

“LOOK FOR HYPERSTIMULATION”

 

 

Ovarian hyperstimulation syndrome is associated with an exuberant ovarian response to HMG or FSH. This can occur rarely in patients ovulating spontaneously or in women taking clomiphene. In this condition, the ovaries enlarge suddenly, and fluid (called ascites) leaks into the abdominal cavity, with or without pain.  Fluid may accumulate around the lungs (called pleural effusion). It is estimated that severe hyperstimulation syndrome will occur in 0.4% to 2.0% of women taking these medications.

 

When moderate to severe hyperstimulation occurs, a number of problems within the body may follow. Urine output may decrease as fluid is transferred into the abdominal cavity and kidney function may be impaired.  When this occurs, admission to the hospital is required to treat your fluid balance and maintain an adequate urine output.  In addition, this dehydration can lead to blood clots to the lungs or other organs which may be life threatening.

 

To monitor your status and to detect early severe hyperstimulation syndrome, we ask that you do the following:

1.   Measure your weight (no shoes and use the same scale) at the same time each day beginning after your hCG shot.

2.   Call us if:

a.   your weight increases by two pounds

b.   your urine output seems to decrease or you seem excessively thirsty

c.   your abdomen seems to enlarge or to be bloated

d.   if you have vomiting, diarrhea, or increasing abdominal pain

e.   if you have further questions

 

 

MONITORING SEVERE OVARIAN HYPERSTIMULATION SYNDROME

 

NAME:_______________________________DATE OF hCG INJECTION:___________________

 

date	weight	fluid intake (cc)	urine output (cc)

 

PLEASE NOTE

 

For high-risk patients undergoing IVF it may not be advisable to transfer embryos in a cycle.  Because of the concern for possible OHSS, it may be necessary to avoid pregnancy at this time.  All embryos would be frozen and transferred during a subsequent cycle.  The physicians will assess the situation with the couple before an embryo transfer is scheduled. 

 

Use the following chart to record your measurements daily

 

date	I & O	morning weight	morning abdominal girth w perform in the AM while lying as flat as possible,    measure your abdomen just below the belly button w mark your abdomen with ink that will not rub off    easily so that you measure in the same spot daily.	Other comments