Treatment of hysteria. Medium and heavy. Moderate treatment

This complication was assigned a code in the ICD-tenth edition: No. 98.1. The frequency of its occurrence ranges from 0.08 to 14%, depending on the number of patients who have undergone IVF. There are reports of fatalities. The forums are full of questions about Hyper. Myths and reality.

Ovarian hyperstimulation syndrome (OHSS, OHSS) is an artificially created condition associated with the stimulation of superovulation by hormones, and which is manifested by a pathological reaction of the ovaries and the body as a whole.

This disease can occur in medium degree, heavy and light. Severe forms of hyperstimulation during IVF occur in 0.2-10% of cases among all attempts. The mortality rate for this complication reaches 1 per 499 thousand women who used this method of fertilization. Hyperstimulation can occur after puncture and embryo transfer.

The most severe cases occur during pregnancy. It is customary to distinguish between early and late ovarian hyperstimulation syndrome. With IVF, early OHSS occurs in the first six days after transvaginal puncture, late OHSS occurs starting from the seventh day.

Its occurrence is associated with implantation of the embryo and the release of a large amount of pregnancy hormone into the blood - human chorionic gonadotropin human (hCG).

Spontaneous ovarian hyperstimulation during IVF and pregnancy are interconnected. OHSS develops on early stages(five to twelve weeks) and is moderate to severe.

Causes

The onset of the syndrome is triggered by the administration of hCG. In response, under the influence female hormones vascular permeability changes. The liquid portion of the blood quickly exits into the peripulmonary space, abdominal cavity, and extracellular space.

The development mechanism is similar to that of serious illnesses heart failure, accompanied by liver cirrhosis. Hypovolemia occurs (decrease in circulating blood volume), its concentration increases (hypercoagulation).

As a result, there is a rapid disruption of the work of all vital important organs and systems. Hyperstimulation during IVF is associated with the effect of hCG on the follicle cells, which contain the active substances involved in this process. The stage of studying OHSS is not completed; many questions about this disease remain open.

Risks

A low risk of developing hyperstimulation syndrome is possible in the following group of patients:

• over 36 years old;
• when ovulation was stimulated with clomiphene;
• overweight;
• with estradiol levels less than 4000 lg.ml;
• when the second phase is supported with progesterone.

High - women with the presence of the following factors:

• under 36 years old;
• those suffering from PCOS;
• with the support of phase II of the menstrual cycle of hCG;
• when ovulation is stimulated by gonadotropin releasing hormone agonists;
• body weight is less than the physiological norm;
• estradiol level above 4000 log.ml;
• pregnancy;
• the result of stimulation in the form of many follicles.

If ovarian hyperstimulation occurs during IVF, symptoms may be varying degrees intensity and have wide range laboratory and clinical signs.

Symptoms

IN mild degree manifestations of the disease are reduced to bloating and minor pain in the pelvic area. Women tolerate this discomfort well.

The average degree has all the above symptoms, but they are more intense. There may be short-term vomiting and loose stools.

In severe cases, signs of hyperstimulation during IVF are clearly expressed:

• intense pain throughout the abdomen;
• shortness of breath may occur;
• high heart rate;
• drop in blood pressure;
• the abdomen becomes enlarged due to fluid effusion (ascites);
• swell soft fabrics in the groin area;
• anasarca (swelling of all tissues);
• breathing is impaired, cough is bothersome;
• dry tongue, nausea, vomiting, loose stools;
• little urine;
• body temperature is increased.

Diagnostics this state requires additional methods examinations: laboratory, instrumental.

Diagnostics

Using general clinical and biochemical blood tests, the following changes are determined:

• increase in hematocrit (an indicator of blood thickening);
• leukocytosis (indicator of inflammatory response);
• increased platelet levels;
• imbalance of electrolytes (potassium more than normal / sodium less);
• low blood protein levels;
• the inflammatory protein CRP is determined;
• increased liver and kidney tests;
• blood clotting factor disorder;
• increased ovarian tumor marker (CA 125);
• protein is determined in urine;
• in microbiological analysis of urine and vaginal discharge– microbial flora;
• high levels of the hormones estradiol and progesterone in the blood;
• with hyperstimulation and pregnancy - high levels of hCG.

Instrumental examination methods complement the examination picture and make it possible to determine the degree of severity.

Ultrasound

With a mild degree: the diameter of the ovaries is 10 cm, contains many luteal cysts and follicles.

Moderate degree - the picture corresponds to a mild degree, but the diameter of the ovaries is larger (up to 12 cm), there is free fluid.

Severe degree - the diameter of the ovaries can reach 13-20 cm, multicystic, fluid (ascites) is detected.

The uterus may be enlarged, with signs of a single or multiple pregnancy. In severe cases, ultrasound detects fluid in the anatomical cavities.

If OHSS is confirmed, further management tactics for the woman are determined taking into account the severity of the manifestations and general condition.

Treatment

If ovarian hyperstimulation occurs during IVF, treatment is prescribed in outpatient setting with light flow. Moderate and severe condition is a direct indication for hospitalization in specialized departments.

Moderate and severe degrees: restoration of circulating blood volume, electrolyte balance, prevention of blood clots. Drugs are prescribed to maintain the functioning of vital organs.

If it develops renal failure, perform hemodialysis. To normalize the rheological functions of the blood - plasmapheresis. Laparocentesis is used in cases of hemoconcentration that is not amenable to other types of treatment, severe renal dysfunction, and an increase in ascites.

This procedure is carried out under ultrasound control, the abdomen is punctured with a thin needle, and the abdominal cavity is drained with a catheter for two weeks to a month. The liquid is removed slowly, in small portions.

The manipulation must be carried out by a highly qualified doctor - the risk of damage to the ovaries and bleeding is high.

If it develops respiratory failure, switch to artificial ventilation lungs. In the case of ovarian hyperstimulation during IVF, treatment is carried out until the manifestations of the syndrome decrease and the hCG levels in the blood decrease. Usually within seven days if pregnancy does not occur and up to twenty days if the embryo is implanted successfully.

Hyperstimulation lasts (on average) for eight to twelve weeks. If the process is delayed, it is necessary to conduct a more extensive examination to exclude malignant ovarian diseases.

In rare situations they resort to surgical treatment OHSS:

• rupture of an ovarian cyst;
• torsion of the uterine appendage;
• bleeding from a burst ovary.

Prevention

• Determining the risk of developing OHSS in patients when choosing a protocol.
• Individual selection of doses for each patient, starting with the smallest ones.
• Prescribing hCG at a shorter interval in order to shorten the period of exposure to achieve ovulation.
• Using lower doses of hCG or replacing it with Clostilbegit, GnRH agonist drugs.
• Observation of women during and after treatment for 14-21 days every day.
• Constant monitoring of estrogen levels, ovarian diameter, number of follicles.
• Assess the risk during the stimulation period: more than 18-20 follicles larger than 0.12 cm, their growth at a rapid pace, high estradiol levels.
• Use of the dopamine receptor agonist drug Dostinex for hyperstimulation, 0.5 mg per day, starting from the day of administration of hCG as an ovulation trigger.
• Women at risk are recommended in parallel with the beginning of stimulation of superovulation protein diet, drinking regime up to 3 liters per day, exclusion of sexual activity and physical activity.

The abolition of PE after IVF, their cryopreservation and subsequent transfer into the uterine cavity in natural or stimulated conditions is considered promising. menstrual cycle. The success rate in this case is 30%. But ovulation is necessary, and the endometrium must be prepared for transfer.

Complications and consequences of ovarian hyperstimulation during IVF can be in the form of vascular thrombosis, renal, cardiac and pulmonary insufficiency, bleeding, pregnancy loss.

If pregnancy occurs, there is a risk of miscarriage throughout the entire gestation period, there is a risk of developing placental insufficiency and premature birth.

Ovarian hyperstimulation is the response of these organs to the administration of the drug and their enlargement. In this case, the body slightly changes various processes: the blood thickens, the capillaries and vessels become thinner, and the fluid leaves the body with difficulty. Unfortunately, this is not yet the biggest problem. If it develops, it will ultimately lead to a syndrome that will be much more difficult to cure.

Ovarian hyperstimulation syndrome today is a common pathology in many women, so each of them should know what the symptoms and causes may be that contribute to the onset of the disease. The most important thing is that if you detect any similar symptoms, you must quickly contact a specialist, otherwise the problem may cause great harm body.

What is OHSS

OHSS (ovarian hyperstimulation syndrome) is serious complication which may occur after the IVF procedure. The main reason, which is identified by doctors who have already studied many details of this disease, is the introduction into the female body of an excessive amount of drugs necessary for

The syndrome can manifest itself at any time. For example, before the uterus or after implantation.

Causes

Modern medicine, although it has achieved enough high level, but still no one can accurately determine the possibility of ovarian hyperstimulation in a particular patient after the procedure. Each woman’s body will react to changes in its own way, so preventing the problem right away will be quite difficult.

But even despite this, doctors have confirmed certain factors that most often contribute to the appearance and rapid development of the disease. For example, this list includes:

• predisposition to pathology at the genetic level in women with natural light hair color under 36 years of age (usually such patients are not prone to obesity);
• transferred ;
• excessive activity of estradiol in the circulatory system;
• allergic reactions to medications which have been confirmed recently.

Foreign scientists have put forward several more points related to the IVF procedure and the most common cases of the disease. So, it can be provoked by:

• significant errors in drug dosage;
• the woman’s body weight is too low (tendency to anorexia, etc.);
• sudden negative reaction for some hormonal drugs;
• similar problems in the past.

Symptoms

When observing the factors listed below, we can say with confidence that ovarian hyperstimulation syndrome is developing. Symptoms will help confirm the exact presence of a problem only if at least half of the proposed list is observed:

1. In the initial stage, the patient will feel some heaviness and weakness. There will be swelling, nagging and sudden pain in the lower abdomen. The patient will urinate significantly more frequently.
2. With moderate severity, nausea and vomiting are the first symptoms, followed by diarrhea, bloating, and weight gain.
3. A severe degree entails more serious changes - frequent shortness of breath, changes in heartbeat. The patient may have hypotension and the abdomen will become too enlarged.

Diagnostics

Only after necessary diagnostics It will become clear how to treat ovarian hyperstimulation syndrome in a particular patient. After all, each person’s body reacts to certain medications differently.

As mentioned above, ovarian hyperstimulation syndrome with IVF is a fairly common problem. Its treatment will not be too simple, but you should not delay contacting a doctor.

Standard diagnosis is carried out based on the following factors:

• Analysis of all patient complaints. For example, when sharp deterioration well-being, she is experiencing frequent pain in the abdomen for no specific reason, alternating nausea and vomiting.
• Mandatory medical history if symptoms began to appear after the release of the egg from the ovary.
• Life history analysis. Previous diseases and the presence of various bad habits, similar cases development of the disease after the IVF procedure.
• Results of a general examination by a gynecologist, palpation of the abdominal areas (the ovaries must be palpated).
• Ultrasonography will accurately indicate the presence of a fetus, and will also make it possible to detect excess liquid, which has accumulated in abdominal cavity.
• Careful laboratory test blood. An excessive amount of sex hormones may be detected here, a general analysis will show the presence of areas of condensed blood, and a biochemical analysis will show subtle signs of changes in the functioning of the kidneys.
• Urinalysis (during this you will see a decrease in urine, an increase in density, and the release of protein along with the urine).
• Electrocardiography, and then ultrasound radiation of the heart (this will detect some abnormalities in cardiac function).
• X-rays chest will show the presence of fluid in the internal cavity of the chest, as well as in the pericardial sac.

Varieties

In total, medicine distinguishes two types of syndrome:

1. Early. It develops immediately after ovulation. In the event that pregnancy does not occur, this means the disappearance of the syndrome and the arrival of a new menstruation.
2. Late. It develops and makes itself felt only in the second or third month of pregnancy. In this case, ovarian hyperstimulation syndrome, the treatment of which will not be easy, is quite difficult.

In addition, there are three main degrees of severity of the disease:

1. Easy. Not too noticeable deterioration in health, some discomfort and swelling in the abdominal area.
2. Average. Abdominal pain, deterioration and swelling are more noticeable. Feelings of nausea and vomiting also become more frequent. And fluid begins to accumulate in the abdominal cavity.
3. Heavy. Severe deterioration in a person’s condition, weakness, is felt very sharp pains in a stomach. The pressure drops and shortness of breath appears due to the accumulated fluid.

Treatment

IN mild case forms of ovarian hyperstimulation syndrome (with IVF), treatment involves only changes in the standard diet:

• You need to create a schedule for fluid intake and strictly adhere to it. It can be not only ordinary mineral water, but also green tea or homemade compote. Alcohol and carbonated drinks should be excluded.
• Eat not too fatty meat, vegetables and boiled fish.
• Physical activity should not be great, and excessive overexertion should also be avoided.

But treatment of moderate and severe forms of the disease takes place exclusively in a hospital. Here, constant monitoring of the patient’s condition is carried out (monitoring respiratory function, work of cardio-vascular system, liver and kidneys). The patient is provided with therapy with drugs that reduce vascular permeability (antihistamines, corticosteroids, etc.), as well as drugs that reduce the threat of thromboembolism (Clexan, Fraxiparine, etc.).

Complications

Ovarian hyperstimulation syndrome can lead to some problems that also harm the patient’s body. These include:

• accumulation of fluid (sometimes up to 20 liters) in the abdominal cavity;
• rupture of one ovary and severe bleeding;
• heart problems (when the muscle cannot function in a normal rhythm);
• depletion of two ovaries prematurely.

How to avoid the problem

Before a woman finally decides on the IVF procedure, doctors should definitely consider all possible preventive measures:

1. Cancel the administration of a certain ovulatory dose of a particular drug used during the procedure.
2. For some time, cancel the embryo transfer and subsequent transfer to the uterus at the next menstruation.
3. Get rid of cysts as much as possible, as well as follicles that constantly appear during the stimulation period.

There are many opinions on how to prevent ovarian hyperstimulation syndrome. Reviews of this kind can be found on various forums on the Internet, but still, to save health, it is not enough to just listen to other people. You need to understand the seriousness of the situation and if any symptoms appear, you should consult a doctor as soon as possible.

Prevention

In addition to the basic methods listed above, there are other methods of prevention. Their action will be much more effective for some patients. After all, women who want to have a child carefully monitor their own health so that their fetus does not have any problems.

Prevention of ovarian hyperstimulation syndrome consists of the following rules:

1. Dosage of any medical product must be verified.
2. The dose of gonadotropins can be reduced if this does not harm the desired result after the procedure. If the dose is successfully reduced, you can be almost one hundred percent sure that the disease has already been avoided.
3. After passing all the tests and undergoing the required procedures, the doctor can make a conclusion about the possibility of freezing the embryo. This will also play an important role in avoiding the problem.

Who is at risk for the disease?

It is impossible to accurately predict who is at risk of developing the disease. But there are the most common cases in which ovarian hyperstimulation syndrome manifested itself. Among them are a small body weight of a girl or woman who decided to undergo the procedure, as well as patients with cystic or polycystic ovary syndrome (this can be a disease either in the present time or already suffered in the past).

Modern medicine has achieved many successes, but it still cannot achieve ideal results. Therefore, before the procedure, no doctor can guarantee the absence of illness after IVF. But if you notice its development in the first stages, then the treatment will not be too long.

Ovarian hyperstimulation syndrome (OHSS)- This pathological condition which develops after use hormonal drugs in order to stimulate ovulation. Clinical manifestations of this syndrome include respiratory and cardiovascular failure, ascites, anasarca, oligoanuria, gastrointestinal disorders. The diagnosis of ovarian hyperstimulation syndrome is established on the basis of a physical examination, general laboratory tests, ultrasound, and chest X-ray. Treatment involves normalization rheological properties blood, if necessary - oxygen support and evacuation of ascitic, pleural or pericardial fluids.

Instrumental diagnostics for ovarian hyperstimulation syndrome is carried out using OGK radiography, ultrasound and ECG. The first technique allows you to determine the presence of fluid in the chest and pericardial cavities, as well as the development of RDS. The ECG may show ventricular extrasystole, a decrease in the amplitude of the waves, and massive electrolyte changes in the myocardium. Ultrasound examination makes it possible to visualize enlarged ovaries, study their structure, determine the presence of free fluid in the abdominal cavity, pleural sinuses and pericardium, and assess the dynamics of the heart.

Treatment of ovarian hyperstimulation syndrome

The essence conservative treatment in case of ovarian hyperstimulation syndrome is to replenish BCC, normalize the rheological properties of blood, prevent the development of multiple organ failure, thromboembolism, RDS and acute renal failure. Hypovolemia is relieved by infusion therapy crystalloids (NaCl 0.9%, combined saline solutions) with further addition of colloids. Pain syndrome eliminated in case of ovarian hyperstimulation syndrome antispasmodic drugs and non-narcotic analgesics. Prevention of thromboembolic complications is carried out using unfractionated heparin or low molecular weight heparins.

In case of RDS, oxygen support or mechanical ventilation is mandatory. In case of severe hemodynamic disturbances or the patient’s critical condition, antibacterial therapy in order to prevent bacterial complications. Surgical treatment in case of ovarian hyperstimulation syndrome, it may involve evacuation of accumulated fluid (laparo- and thoracentesis, pericardial puncture), midline laparotomy for internal bleeding, torsion or rupture of the ovary, etc.

Forecast and prevention of ovarian hyperstimulation syndrome

The prognosis for a woman with ovarian hyperstimulation syndrome is usually good. With successful fertilization, there is a risk of spontaneous abortion in the first and second trimesters, fetoplacental insufficiency and premature birth in the third trimester. Prevention of ovarian hyperstimulation syndrome includes detailed adherence to the instructions of the treating obstetrician-gynecologist, the use of lower doses of drugs in the presence of risk factors for OHSS, balanced diet with the consumption of a large volume of fluid, prevention of physical or psycho-emotional overload, a full examination before the start of ovulation stimulation, abstinence from sexual activity.

Ovarian hyperstimulation is a pathological reaction of a woman’s body to a specific hormonal treatment before or after IVF. Statistics on the incidence of this pathology vary from 0.5 to 30%. This discrepancy is due to different treatment regimens in clinics and some other factors.

Ovarian hyperstimulation syndrome (OHSS) is real threat for a woman’s life, especially when providing unqualified assistance. Why and who gets the condition, what can it lead to and how to deal with it correctly?

Read in this article

Causes of ovarian hyperstimulation syndrome

Hyperstimulation syndrome can occur during the maturation and ovulation of one or several eggs; isolated cases of the appearance of OHSS in its own cycle without any external influences have been described.

Normally, after the egg is released from the ovary, a corpus luteum forms in this place. The process is accompanied by expansion blood vessels, activation of various substances (interleukins, tumor necrosis factor, “X” and others). At the same time, the permeability of the capillaries increases, and a certain amount of plasma enters the abdominal cavity. Normally, this does not bring the woman any discomfort, pain or anything like that.

With artificial stimulation, not one, but two or three and sometimes even more than ten eggs often mature. It is also impossible to predict how sensitive a woman is to all medications used. As a result, almost the same thing happens as normally, but to a different extent. This leads to more fluid leaking into the abdominal cavity, up to several liters.

These mechanisms do not go unnoticed in the body; other processes are activated. The result is a vivid clinical picture, sometimes with life-threatening complications.

The mechanism of occurrence of OHSS can be described as follows:

• From the blood vessels, plasma along with proteins exits into the abdominal cavity. This leads to pain and symptoms of peritoneal irritation (“ acute abdomen"), nausea, vomiting, etc.
• Since there is less plasma in the vessels, the blood thickens greatly. And this directly provokes the formation of blood clots, pulmonary embolism, etc.
• The blood supply to the kidneys is impaired due to a decrease in blood volume. This leads to kidney failure. Other organs can react in the same way. Therefore, a woman often needs resuscitation measures.

Risk factors for developing OHSS

It is impossible to predict the likelihood of developing ovarian hyperstimulation syndrome. But there is a certain risk group among all girls planning pregnancy using. These include:

• With a large supply of eggs. At the same time, several follicles respond during stimulation, which subsequently leads to the launch of an extensive mechanism. The number of supposed active eggs is in practice checked using an anti-Mullerian hormone test, the value of which correlates with a woman’s fertility.
• Young age of girls: the younger the patient, the more eggs she still has.
• Body weight deficiency. This is due to the lack of compensatory capabilities of the body. With low weight, even a relatively small plasma effusion will lead to serious consequences.
• Use of hCG or gonadotropic hormones as stimulation according to a long-term protocol.
• Multiple pregnancy.
• If a girl has ever had OHSS, then the severity of symptoms during the next IVF is in most cases greater.
• If a girl suffers from various kinds of allergic reactions.
• In polycystic ovary syndrome, OHSS is also much more common.

Symptoms of ovarian hyperstimulation syndrome

The severity of symptoms in OHSS depends on the severity of the pathology.

At mild form The woman is practically not bothered by anything; as the condition progresses, the symptoms worsen.

The clinical picture does not depend on whether OHSS developed immediately after the puncture, during pregnancy, or after embryo transfer. Symptoms may include the following:

• . The intensity varies depending on the severity of ascites. At the same time, the abdominal circumference will increase.
• Difficulty breathing due to fluid accumulation in the pleural cavity and creating pressure on the diaphragm. Shortness of breath appears.
• Nausea, vomiting, bowel dysfunction due to intestinal irritation.
• The appearance of swelling of the arms, legs, abdominal wall and the whole body is anasarca.
• In severe cases, rhythm disturbances, a sharp decrease in pressure, etc. may appear.

If the pregnancy is established, then mild degree OHSS must be differentiated from the threat of interruption. Nausea, vomiting, weakness, nagging pain lower abdomen will be common to all these conditions.

Types of OHSS

Classification of OHSS is carried out taking into account the severity and severity of symptoms. The following stages are distinguished:

• 1 and 2 are considered mild manifestations of OHSS. In this case, the ovaries increase to no more than 6 cm in diameter. A woman is worried about minor pains in the lower abdomen, she may not even seek treatment medical care.
• Stages 3 and 4 are considered moderate. The ovaries can enlarge up to 12 cm, and to all the previous symptoms are added ascites (fluid in the abdominal cavity), vomiting and nausea, and less commonly, diarrhea.
• Stages 5 and 6 are considered severe manifestations of OHSS. Against the background of sharply enlarged ovaries (more than 12 cm), there are signs of hypovolemia (decreased blood volume): low blood pressure, confusion, impaired renal function, and others. Ascites is pronounced, as well as hydrothorax (fluid in the pleural cavity), hydropericardium (near the heart), etc.

Thrombosis, acute renal failure, liver dysfunction, swelling of the entire body (anasarca) and other symptoms may occur. At this degree OHSS treatment carried out only in an intensive care unit.

According to the time of occurrence they distinguish the following types: early and late. In the first case, all symptoms of hyperstimulation occur within 5 to 6 days after puncture of the ovaries to collect eggs. With late OHSS - on the 7th day and beyond, even in the early stages of pregnancy.

The severity of symptoms does not depend on the time of occurrence.

Watch the video about ovarian hyperstimulation syndrome:

Diagnosis of ovarian hyperstimulation syndrome

In most cases, ovarian hyperstimulation syndrome occurs after a woman leaves the IVF center. Therefore, diagnosis and treatment have to be carried out by general doctors. When making a diagnosis, do the following:

• An anamnesis is collected, in which it becomes known when IVF was performed, what drugs were used for stimulation, what kind of attempt it was, etc.
• Held general examination and special (gynecological). As a result, the doctor prescribes additional examination and determines the severity of OHSS.
• An ultrasound of the pelvis and abdominal cavity is performed, which can reveal signs of ascites, etc.
• Ultrasound of the heart, pleural cavity, and x-ray of the lungs can detect fluid accumulation in these places.
• If necessary, an ECG and some other research methods are performed.
• Mandatory general analyzes blood and urine, biochemical profile and others.

Treatment of ovarian hyperstimulation syndrome

Treatment can be carried out either on an outpatient basis (for mild cases), or in a gynecological hospital, and even in intensive care (for severe cases). Rarely, but if complications occur (rupture or torsion of the ovary), emergency surgical care. The main directions of therapy are as follows:

• Bed rest.
• Sufficient fluid intake into the body - drinking plenty of fluids or intravenous infusions of solutions. Moreover, mostly not ordinary “water” - saline solution, but special ones, for example, HES (hydroxyethylene starch), etc. The latter do not sweat again so quickly in the body cavity.
• Drugs to reduce the permeability of the vascular wall. This also allows you to avoid blood thickening and all subsequent disorders (acute renal failure, pulmonary embolism, etc.).
• If necessary, fluid is evacuated from the cavities where it has accumulated (puncture of the abdominal cavity, pleural cavity, etc.). But this is rather a “step of desperation” to reduce the pressure on internal organs and somehow temporarily reduce the severity of the process. After the fluid is evacuated, it immediately begins to penetrate there again if adequate basic symptomatic treatment is not carried out.
• If acute renal failure occurs, hemodialysis may be used temporarily.
• To prevent infection in moderate and severe OHSS, antibacterial drugs are prescribed.
• If OHSS develops during pregnancy, preservative therapy (antispasmodics, hormonal and others) is additionally prescribed.

In any case, treatment must be comprehensive, competent and timely. Therefore, after IVF or ovarian puncture, it is necessary to seek medical help if even the slightest unpleasant symptoms appear.

Complications that may occur with OHSS

Mild and moderate degrees of OHSS in most cases resolve without any consequences. But they can go to severe forms, and also have an unpredictable course. The most common complications you encounter are:

• Ascites, the volume of accumulated fluid can reach 15 - 20 or more liters.
• Acute cardiac, pulmonary and renal failure. All of these conditions require emergency medical attention.
• Rupture and torsion of the ovary, disruption of its nutrition. These conditions require surgical treatment.
• As a long-term consequence, ovarian exhaustion syndrome may occur due to their constant stimulation by drugs. This can develop 3 to 5 years after IVF and manifests itself as premature menopause.

Prevention of ovarian hyperstimulation

Prevention of development is as follows:

• It is necessary to plan your pregnancy and undergo a thorough examination the day before.
• When choosing drugs for stimulation, one should take into account all previous IVF attempts and the woman’s body’s reaction to the drugs.
• During planning, the girl needs to maintain mental and physical rest, eat properly and balancedly, and drink enough fluids.

Ovarian hyperstimulation syndrome is a serious condition that requires a competent approach and individual treatment. It is less common today, but can still be life-threatening. In order to avoid this, you should carefully approach the schemes and methods of stimulation, and observe the woman’s reaction.

Ovarian hyperstimulation is a pathological condition female body associated with a malfunction in the reproductive system. Mainly develops after administration specific drugs during preparation for artificial insemination or before egg donation.

IN in rare cases may occur independently in the natural menstrual cycle. Treatment of the syndrome is carried out in a hospital, since there is a high risk of complications - ascites, torsion of the uterine appendages, rupture of the ovary, depletion of the gonads.

To reduce the risk of developing OHSS, the IVF procedure should be carried out by a trusted specialist who can select the correct medications and their dosage, taking into account all individual characteristics patients.

Physiologically, in one menstrual cycle, a woman matures a single egg in one of the ovaries. Sometimes it happens that in fallopian tubes two germ cells enter at once, in this case fraternal twins are born, and this is also considered the norm.

During the procedure of artificial insemination or simply oocyte donation, the patient is prescribed a course of drugs that dramatically change the woman’s hormonal levels. Because of this, a larger number of eggs begin to mature in the ovaries at the same time, usually no more than six.

With the correct dosage of hormonal agents, the uterine appendages cope with stress, and after 1-2 cycles there are no changes in the body.

Ovarian hyperstimulation develops in case of excessive influence on the functioning of the gonads. A large number of follicles quickly mature, they rupture, damaging the lining of the ovaries and releasing fluid into the abdominal cavity.

The appendages increase in size, become inflamed, and apoplexy (rupture) of the ovary may occur.

Causes

Normally, after the follicle ruptures, a temporary gland is formed at the site of damage - the corpus luteum. It releases specific substances that affect the woman’s body, preparing it for pregnancy.

The permeability of the capillary wall increases, the vessels dilate, and the active ingredients blood (interleukins, tumor necrosis factors, etc.).

Due to these changes, a small amount of the liquid component of the blood (plasma) leaks into the peritoneal cavity, irritating it.

Usually this process is not accompanied by changes in the woman’s condition; particularly sensitive patients may experience minor discomfort. However, when several are formed in the appendages at once yellow bodies, the impact on the body increases several times.

Because of this, more fluid enters the peritoneum, in severe cases more than a liter of plasma. As a result, the woman’s condition worsens, and the clinical picture of hyperstimulation syndrome develops.

Forms of OHSS

Depending on when the symptoms of the syndrome began to develop, early and late ovarian hyperstimulation are distinguished.

Early occurs in the middle of the cycle, immediately after ovulation. If pregnancy does not occur, then menstrual bleeding begins on the expected day, and the ovaries recover on their own.

In the event that fertilization occurs, the woman requires constant monitoring and treatment. If hyperstimulation is severe, doctors may recommend terminating the pregnancy.

Late pregnancy makes itself known after pregnancy, usually at the end of the third trimester. Has severe symptoms and is difficult to treat drug therapy, often leads to spontaneous abortion.

Read also: Methods for treating ovarian cysts at home

Symptoms

Symptoms of ovarian hyperstimulation are manifested by dysfunction different systems body, however, all disorders are associated with changes in plasma concentration in the blood.

The kidneys and heart suffer the most; changes also affect the lungs - fluid accumulates in them, hydrothorax develops.

The severity of damage to the body depends on the severity of symptoms due to ovarian hyperstimulation. There are four variants of the pathological syndrome, which can replace each other as stages.

Mild severity

Almost every ovarian stimulation is accompanied by mild symptoms. Women complain of discomfort in lower sections abdomen, increased fluid consumption, nagging pain.

During the examination, tension in the abdominal muscles and bloating can be determined. With palpation, it is possible to palpate the enlarged ovaries.

When carrying out ultrasound diagnostics, a large number of follicles and the presence of luteal cysts are visible, but the diameter of the appendages does not exceed 6-8 cm. Liquid is observed in the pelvis, but its amount does not exceed several ml. There are no pathological changes in the blood test.

Average degree

Characterized by a woman’s moderate condition, the intensity of symptoms increases and intensifies painful sensations. This is due to an increase in the uterine appendages and the accumulation of the liquid part of the blood in the pelvic cavity.

In addition, disruptions in work gastrointestinal tract– heaviness, nausea, diarrhea and vomiting. The abdominal circumference becomes larger, body weight increases by several notches due to accumulated fluid.

Upon examination, tachycardia (excessive heartbeat) and increased breathing are detected. The ultrasound image shows ovaries, the size of which reaches 12 cm, and there is fluid in the pelvic cavity.

Severe degree

The patient is in serious condition and is in forced sitting position in bed, because the accumulated fluid compresses the lungs and makes it difficult to breathe.

Floaters appear before the eyes, an insurmountable fear of death, dizziness and pain in the head. Respiratory failure may develop, as well as severe disturbances in the functioning of the cardiovascular system.

On examination, significant tachycardia and shortness of breath are noted; the body temperature often rises due to the addition of an infection to the weakened body. The face and limbs swell, and anasarca (swelling of the entire body) is sometimes observed.

Severe degrees are always accompanied by severe ascites (fluid in the peritoneal cavity), pleural and pericardial effusion. The size of the ovaries ranges from 12 to 25 cm; due to hyperovulation, the appendages are completely covered with follicles and cysts.

The functioning of the urinary system is disrupted - the amount of urine decreases, its density and concentration increase harmful substances. Blood thickening significantly increases the risk of thrombosis pulmonary artery, heart attack.

Critical degree

The patient is in extreme in serious condition, complaints do not change compared to the previous severity, however, internal violations are more global in nature.

Critically reduced arterial pressure, up to collapse, there is shortness of breath and tachycardia, the liver increases in size.

The abdomen becomes huge, its muscles are tense, and large ovaries can be easily felt in the lower sections. Liquid in large quantities accumulates in everyone possible cavities body - pleural, pericardial, abdominal. Acute respiratory and heart failure develops.

The blood thickens greatly, kidney and liver failure develops, resulting in severe intoxication. Often the critical stage is accompanied by vascular thrombosis, pulmonary embolism.

Without timely and competent assistance, OHSS leads to multiple organ failure and death.

Who can it threaten - risk groups

It is impossible to accurately predict in advance the body’s reaction to the introduction of unnatural doses of hormonal hormones. active substances, however there is certain dependence from some factors. The following groups of patients are more susceptible to OHSS than others:

• history of polycystic ovary syndrome;
• frequent allergies;
• in vitro fertilization in the past;
• oocyte donors;
• young girls with blond hair and light weight;
• estradiol hyperactivity.

Read also: Treatment of two-chamber ovarian cyst - symptoms of pathology

The presence of one of these factors does not give 100% confidence that hyperstimulation will occur, however, such girls need to be treated more carefully and medications must be selected especially carefully.

How is OHSS diagnosed?

Particular attention is paid to the anamnesis, or rather, stimulation in the past. Basically, the diagnosis is made on the basis of the characteristic clinical picture, as well as data ultrasound diagnostics. It shows enlarged ovaries, effusion, the presence of cysts and follicles.

In addition, various laboratory tests are carried out.

Blood and urine tests

On initial stages Blood or urine tests are uninformative, however, as the syndrome develops, characteristic changes appear. The percentage of hematocrit in the blood increases, that is, the dry fraction, and accordingly, thickening occurs, and leukocytosis is also noticeable.

Changes in urine are characterized by a significant decrease in its quantity and an increase in density. In addition, it becomes more concentrated.

How does the syndrome develop during IVF?

The development of OHSS during in vitro fertilization is common; a mild form occurs in almost every girl, but the appearance of a severe syndrome is preceded by errors and carelessness of specialists.

It is important to choose the right dose of drugs and the regimen for taking them, otherwise the results can be disastrous. In case of an error, the ovaries are subject to excessive influence, and a pathological syndrome develops.

Ovarian hyperstimulation during IVF occurs during pregnancy or at the very beginning, even before oocyte collection. In the first option, if fertilization does not occur, the pathology usually goes away on its own. But the appearance of OHSS already during pregnancy necessarily requires medical attention.

How to avoid ovarian hyperstimulation during IVF

To avoid OHSS during in vitro fertilization, you should carefully prepare for a number of procedures:

• find experienced specialist with good reviews;
• pass the comprehensive examination the whole body;
• to refuse from bad habits;
• avoid stress and overwork;
• cure acute diseases and put chronic pathologies into remission;
• carefully follow all doctor's recommendations.

Important! You cannot repeat stimulation of the appendages within a short period of time after the first attempt. Such actions almost always lead to hyperstimulation and depletion of the ovaries.

Treatment of ovarian hyperstimulation syndrome - 3 stages

There isn't any specific treatment ovarian hyperstimulation, so help comes down to symptomatic therapy and alleviation of the patient's condition.

In the initial stages, the girl can stay at home, but severe forms of OHSS require hospitalization in a gynecological hospital or even in the intensive care unit.

Light form

The mild form always occurs after in vitro fertilization; there is no need to treat it. Doctors recommend normalizing your lifestyle, getting plenty of rest and avoiding overuse liquids.

Important! You need to eat more fruits and vegetables, avoid fried and fatty foods. Alcohol is strictly prohibited.

Medium to heavy

Treatment of moderate and severe syndrome after ovarian stimulation must be carried out in a hospital. Main aspects of treatment:

• bed rest - the body is already under stress; in difficult situations, girls are not even allowed to get up to go to the toilet;
• the intake of a sufficient amount of fluid into the body is achieved by drink plenty of fluids and parenteral administration of solutions (intravenously). It is advisable to place droppers not with ordinary saline solution, but with special mixtures that penetrate more slowly through vascular wall, for example, HES;
• decreased vascular permeability - drugs are prescribed that strengthen the walls of blood vessels, preventing fluid from moving from the blood into the intercellular space. This helps prevent blood thickening and the development of thrombosis;
• hemodialysis - used in critical condition, when acute renal failure occurs, helps to avoid intoxication of the body;
• antibacterial agents - used to prevent infections that easily cling to a weakened patient.