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Ovarian hyperstimulation syndrome


Disease: Ovarian hyperstimulation syndrome Ovarian hyperstimulation syndrome
Category: Gynecological diseases

Disease Definition:

Taking gonadotropins, which are hormonal medications that stimulate the production of eggs in a woman’s ovaries, may result in ovarian hyperstimulation syndrome (OHSS). Irregular ovulation or infertility may be treated with these prescription injectable fertility medications. The ovaries become swollen and painful in ovarian hyperstimulation syndrome.


A mild type of ovarian hyperstimulation syndrome that disappears after about a week develops in about one-fourth of women using gonadotropins. However, symptoms of ovarian hyperstimulation syndrome might linger for several weeks in case a woman becomes pregnant after taking one of these fertility medications. Additionally, a more severe type of ovarian hyperstimulation syndrome that can result in rapid weight gain, vomiting, shortness of breath and abdominal pain, may develop in less than 2 % of women given fertility medications.

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Symptoms, Causes


Usually, three to ten days after a woman takes drugs to stimulate ovulation, symptoms of OHSS may develop. The severity of OHSS symptoms differs, which may either get worse or improve with time.



Some of the symptoms of the mild type of OHSS may include:


  • Mild nausea
  • Vomiting
  • Tenderness in the area of the ovaries
  • Diarrhea
  • Mild to moderate abdominal pain that might appear and disappear
  • Abdominal bloating or increased girth



Some of the symptoms of the more severe type of OHSS may include:


  • Severe abdominal pain
  • Dark urine
  • Reduced urinary frequency
  • Dizziness
  • Tight or enlarged abdomen
  • Severe, persistent vomiting and nausea
  • Shortness of breath
  • Rapid weight gain, such as an increase of 5 to 10 pounds in one to two days, or weight gain of more than 10 pounds in three or more days.


A doctor should be consulted in the case of having symptoms of ovarian hyperstimulation syndrome. The doctor would want to observe the patient for weight gain or symptoms that are getting worse even if she has the mild form of the syndrome. Additionally, medical attention should be sought in case the symptoms are severe, last longer than a week or become worse.


After taking a fertility medication that acts directly on the ovaries stimulating them to produce multiple eggs, OHSS occurs. Controlled ovarian stimulataion is the name of this treatment that is more likely to result in symptoms of ovarian hyperstimulation than is the more common approach to inducing ovulation, which is treatment with clomiphene, a medication that acts on the pituitary gland.
Gonadotropins are the hormonal medications that mostly result in OHSS. They might include:


  • Human menopausal gonadotropin (hMG), which has both LH and FSH
  • Follicle-stimulating hormone (FSH) that stimulates the formation of multiple fluid-filled cysts (follicles) where eggs mature
  • Human chorionic gonadotropin (HCG), a substitute of the LH surge that in natural cycles results in the follicle’s release of the egg.
  • Luteinizing hormone (LH) that supports egg maturation and triggers ovulation


OHSS takes place only after the follicle-stimulating phase of an ovulation-induction cycle, when receiving an injection of HCG triggering ovulation. Commonly, signs and symptoms occur within the first ten days after the injection, when the ovarian blood vessels start to leak fluid due to having an abnormal reaction to the hormone. This fluid fills the follicles, swells the ovaries and occasionally moves into the abdomen in large quantities.


Because pregnancy itself results in a natural increase in HCG levels, OHSS may sometimes develop throughout a pregnancy achieved following ovulation induction. Rarely, OHSS have additionally, took place in pregnant women who conceived without ovulation induction. In some rare cases, pregnant women who conceived without ovulation induction have developed OHSS.


Factors raising the risk of developing OHSS include:


  • Young age
  • Low body weight
  • Previous episodes of OHSS
  • Polycystic ovary syndrome, a common reproductive disorder that contributes to irregular menstrual periods, extra hair growth and abnormal findings on ultrasound examination of the ovaries.
  • Large number of follicles
  • High or steeply increasing level of estradiol (estrogen) preceding an HCG shot


Young women with polycystic ovary syndrome are at an increased risk of ovarian hyperstimulation syndrome. However, these risk factors don’t predict precisely who will get OHSS, and in some cases, women with no risk factors may develop this syndrome.



A severe type of ovarian hyperstimulation syndrome occurs in about 1 to 2% of women undergoing ovarian stimulation. Severe OHSS may cause some of these complications: 


  • Kidney failure
  • Fluid collection in the abdomen (ascites) and occasionally the chest
  • Blood clots in large vessels, often in the legs
  • Breathing problems, such as adult respiratory distress syndrome
  • Twisting (torsion) of an ovary
  • Rupture of a cyst in an ovary that can contribute to serious bleeding
  • Electrolyte disturbances (sodium, potassium, others)


While OHSS is not considered to be fatal, yet some of the above mentioned complications might be life-threatening. The chance of pregnancy loss, either through miscarriage or termination due to complications is increased by severe OHSS.


Although ovarian hyperstimulation syndrome may take longer to disappear if the woman is pregnant, but if not, it usually disappears on its own within a week or two. The goal of treatment is to keep the woman comfortable, avoid complications and reduce her ovarian activity.



In the case of mild symptoms, the below mentioned recommendations should be followed:


  • Avoiding sexual intercourse, as it might be painful and could result in a cyst in the ovary to rupture.
  • Consulting a doctor when signs and symptoms worsen
  • Taking over-the-counter painkillers to ease abdominal discomfort, like acetaminophen or ibuprofen
  • Weighing oneself on the same scale each day, and reporting to the doctor about any rapid or unusual weight gain.



A doctor should be seen if symptoms get worse rapidly or last longer than a week. The guidelines for mild OHSS should be followed in addition to the below suggestions.


Treatment for moderately severe OHSS might involve:


  • Having frequent physical exams and ultrasound exams
  • Measuring the urine output each day
  • Taking either anti-nausea medications or prescription painkillers or both
  • Drinking large quantities of fluids, like sports drinks including electrolytes and a carbohydrate solution
  • Seeing a doctor to get blood tests to monitor for problems such as dehydration and electrolyte imbalance among others.
  • Weighing oneself each day and measuring the abdominal girth, noting any changes that may occur
  • Remaining as active as possible and wearing support stockings to help prevent blood clots
  • Draining extra fluid via a needle inserted in the abdominal cavity.



The patient might need to be hospitalized for careful monitoring and more aggressive treatment including intravenous (IV) fluids in the case of developing signs or symptoms of severe illness. Surgery for a ruptured ovarian cyst or intensive care for liver or lung complications may be needed in the case of serious complications.


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