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Signs of ovarian hyperstimulation and methods of treating the disease. How dangerous is ovarian hyperstimulation syndrome and methods of its treatment Signs of ovarian hyperstimulation after embryo transfer

Ovarian hyperstimulation syndrome (OHSS) is a pathological condition that develops after the use of hormonal drugs to stimulate ovulation. Clinical manifestations of this syndrome include respiratory and cardiovascular failure, ascites, anasarca, oligoanuria, and 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 the normalization of the rheological properties of the blood, if necessary - oxygen support and the evacuation of ascitic, pleural or pericardial fluids.

General information

Ovarian hyperstimulation syndrome is a systemic pathology in obstetrics and gynecology, which develops as a result of excessive activation of the synthesis of steroid hormones by the ovaries against the background of stimulation of superovulation. This syndrome was first described in 1943. The overall prevalence of ovarian hyperstimulation syndrome, according to various sources, ranges from 0.4% to 35% of cases of all stimulation schemes. Severe forms are much less common - 0.1-10%. The mortality rate is 1 case per 45,000-50,000 women. The main cause of death in OHSS is adult respiratory distress syndrome or thromboembolism, less often acute kidney failure or gastrointestinal damage.

Causes of ovarian hyperstimulation syndrome

The immediate cause of the development of ovarian hyperstimulation syndrome is the body's reaction to hormonal drugs that affect ovulation. As a rule, such funds are used in in vitro fertilization or egg donation, in the treatment of infertility and anovulatory cycles, etc. As a result, the ovaries produce an excessively large amount of steroid hormones (progesterone and estrogen). A high concentration of hormones leads to systemic damage to the endothelium and an increase in the permeability of the vascular wall. Against the background of a generalized release of a protein-saturated fluid outside the vessels, fluid accumulates in the body cavities and interstitium.

Ovarian hyperstimulation syndrome is also manifested by a hyperdynamic type of blood circulation. This concept includes a decrease in blood pressure, an increase in cardiac output, a drop in peripheral vascular resistance and an increase in the tone of the sympathetic part of the peripheral nervous system. The leading role in the genesis of ovarian hyperstimulation syndrome is played by stimulation of the renin-angiotensin-aldosterone system, which causes high levels of interleukins and TNF fractions α and β in the blood. Experts admit the existence of a genetic predisposition to ovarian hyperstimulation syndrome. Separately, risk factors are identified that increase the likelihood of its development. These include incorrect selection of the dose of drugs for stimulation or its non-compliance, underweight, and episodes of OHSS in the anamnesis.

Classification of ovarian hyperstimulation syndrome

Based on clinical and laboratory characteristics, four degrees of severity of ovarian hyperstimulation syndrome are distinguished:

mild OHSS. The general condition is not disturbed. Blood pressure and heart rate are within normal limits. Complaints of minimal discomfort, a feeling of heaviness in the hypogastrium. The diameter of the ovaries according to ultrasound scanning is up to 8 cm. Hematocrit is less than 40%.
Moderate OHSS. There is an increase in mild symptoms, nausea, vomiting, and less commonly diarrhea. The general condition remains normal. Heart rate and RR may increase slightly, and blood pressure may decrease. There is an increase in body weight and abdominal circumference. On ultrasound, the ovaries are more than 8 cm, signs of ascites. Ht – 40-45%.
Severe OHSS. The complaints are similar, but more intense and may be accompanied by fear. The general condition is moderate or severe. There is a significant decrease in blood pressure, tachycardia, fever, shortness of breath of a mixed or inspiratory nature. There is a pronounced increase and tension in the abdomen. The first signs of hydropericardium and hydrothorax are possible. Anasarka. The diameter of the ovaries on ultrasound is over 12 cm. Laboratory tests determine leukocytosis over 15x109/l, oliguria, hypo- and dysproteinemia. Ht - 45-55%.
Critical OHSS. The complaints are similar. Massive ascites and hydrothorax are detected. The development of respiratory distress syndrome (RDS), acute renal failure and thromboembolism is characteristic. Anuria and leukocytosis of 25x109/l or more are determined in the laboratory. Ht - more than 55%.

Symptoms of ovarian hyperstimulation syndrome

Typically, clinical manifestations of ovarian hyperstimulation syndrome occur 2-5 days after the use of stimulant drugs. Their combination and intensity vary depending on the severity of the pathology. The woman is in a forced position (half-sitting). The general condition ranges from normal to severe. Weight gain is often observed. The skin becomes pale and dry. Acrocyanosis often develops. Swelling of the arms and legs or anasarca may occur. Fever in ovarian hyperstimulation syndrome is a sign of infectious complications, most often from the genitourinary or respiratory system. Less commonly, it occurs against the background of internal pyrogenic reactions.

Damage to the respiratory and cardiovascular systems in OHSS is manifested by tachypnea, inspiratory or mixed shortness of breath, tachycardia, a feeling of increased heartbeat or rhythm disturbance. Gastrointestinal disorders in ovarian hyperstimulation syndrome include nausea, repeated vomiting, and less commonly, diarrhea. There is severe discomfort or pain in the hypogastric region. Pain syndrome during OHSS is of a pulling or stabbing nature of varying intensity with possible irradiation to the groin and intensification with movements or turns of the body. Against the background of hypovolemia and hypotension, kidney function is disrupted - oligoanuria and acute renal failure occur.

Diagnosis of ovarian hyperstimulation syndrome

Anamnestic data in favor of ovarian hyperstimulation syndrome are indicated by ongoing stimulation programs in a given ovulatory cycle, non-compliance with dosage, or the presence of other potential etiological factors. The complaints that the patient may make depend on the severity of the pathology. A physical examination of women with ovarian hyperstimulation syndrome reveals unimpeded palpable enlarged ovaries and signs of fluid accumulation in the body cavities. There is also tachypnea, dullness of percussion sound in the basal parts of the lungs, weakened breathing during auscultation or its complete absence (hydrothorax), tachycardia, muffled heart sounds, hypotension, expansion of the boundaries of cardiac dullness (hydropericardium), enlargement and tension of the abdomen, bulging of the navel, ascites .

In the CBC, with ovarian hyperstimulation syndrome, leukocytosis of varying severity and symptoms of hemoconcentration (relative erythrocytosis, increased Hb and Ht, thrombocytosis) are determined. Urine tests can reveal the presence of protein (proteinuria) and decreased urine output (oligoanuria). In a biochemical blood test for OHSS, an increased concentration of potassium and a decreased concentration of sodium, hypo- and disproteinemia, and an increase in C-reactive protein are observed.

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 of conservative treatment for ovarian hyperstimulation syndrome is to replenish blood volume, 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 with crystalloids (NaCl 0.9%, combined saline solutions) with further addition of colloids. Pain syndrome in ovarian hyperstimulation syndrome is eliminated by antispasmodics 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 is carried out in order to prevent bacterial complications. Surgical treatment for ovarian hyperstimulation syndrome 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, a balanced diet with the consumption of large amounts of fluid, prevention of physical or psycho-emotional overload, a full examination before ovulation stimulation, abstinence from sexual activity .

Ovarian hyperstimulation during IVF (abbreviated OHSS) is one of the serious complications after the procedure. Each specialist, during a discussion with the patient, must inform her about the risk of OHSS.

Ovarian hyperstimulation syndrome occurs as a reaction to hormonal drugs (prescribed for). Their use contributes to the production of too much. As a result, the blood begins to thicken, capillaries and blood vessels weaken, and fluid begins to accumulate in the body, filling the tissues and causing swelling. The reaction of the ovaries is manifested in their enlargement.

Women with a genetic predisposition to this disease or those undergoing long-term infertility treatment are more often at risk. Most often, the syndrome begins to develop before pregnancy (during stimulation). Capable of forming even before the moment when the embryo is transferred to the uterus. But symptoms appear only after the embryo moves into the body of the uterus.

In cases of successful fertilization, the patient undergoes a natural restructuring of the body’s hormonal levels and her health deteriorates. Early manifestations of OHSS threaten a large number of complications later and long-term treatment. The pain caused by the syndrome may persist throughout the first trimester.

How does the syndrome develop?

The female body, by nature, is capable of forming only one mature egg per month cycle. For some patients, this is not enough for fertilization to occur. Modern medicine of reproductive technology offers a method of stimulating the body with hormones. As a result, several eggs mature in the follicles simultaneously (up to 20 eggs). Then the chances of successful fertilization increase significantly.

The other side of reproductive technology using hormone stimulation is that the level in the body begins to increase. This affects the walls of blood vessels, which become too permeable. Liquid plasma freely begins to leave the bloodstream. This affects other organs of the body, which begin to swell. In a toga, a woman is threatened with the development of the following diseases:

development of ascites - fluid accumulates in the abdominal cavity;
development of hydropericardium - the pericardial sac (the space that is located around the heart muscle) begins to fill with fluid;
the development of hydrothorax - the cavity in the chest is filled with fluid.

Complications in the form of ovarian hyperstimulation are accompanied by their strong increase. From this, their protective shell begins to suffer. As it stretches, the woman begins to experience pain of varying intensity in the lower abdomen.

3 stages of hyperstimulation

The ovaries can increase in size up to 20 cm.

At the initial stage, an enlargement of the ovary is observed within the range of 5.5–10 cm in diameter. A woman may experience slight discomfort in the lower abdomen.
At the middle stage, the increase can reach 12.5 cm. The general condition worsens - the intensity of pain increases, nausea, gag reflex and diarrhea may occur. At this stage, specialists determine pronounced edema (ascites begins to develop).
The severe stage is determined by the size of the ovaries up to 20 cm. A large accumulation of fluid provokes in a woman: shortness of breath, repeated vomiting, low blood pressure. At this stage, hydrothorax begins to develop, accompanied by disturbances in the functioning of the heart.

Important: The sooner ovarian hyperstimulation syndrome begins to manifest itself, the more difficult it will be to undergo treatment. The prognosis of this syndrome is unpromising.

For women whose bodies are predisposed to this pathology, the chances of conceiving a child are halved. In cases where the fertilized egg was unable to take root in the uterus, the symptoms of the disease disappear on their own immediately after the start of the menstrual cycle. When fertilization is successful and the pregnancy begins to develop, the symptoms increase and the woman’s well-being worsens.

Which women are at risk?

When the method of in vitro fertilization was chosen for conception, it becomes impossible to predict which of the patients may develop ovarian hyperstimulation syndrome.

women whose body (and the ovaries separately) is too sensitive to the effects of hormonal drugs that stimulate ovulation;
women with low weight and asthenic body shape;
the patient’s age has not reached 35 years;
the patient already had an increased level of estradiol in the blood, and stimulation provoked an even greater increase;
a woman’s body is prone to frequent allergic reactions;
the woman has polycystic ovaries;
when the woman has already undergone stimulation with hormonal drugs and there has already been a case of developing OHSS;
the risk of the syndrome also increases when a woman is supported with hCG drugs during the luteal phase.

Interesting: It was also noted that the syndrome develops more in fair-haired women with low body weight.

OHSS can develop due to doctor error. The specialist incorrectly determined the individual dosage of hormonal drugs.

Symptoms of OHSS depending on the stage of development

Signs of OHSS may vary. They will depend on the intensity of the syndrome, as well as on its degree. In the first degree, a woman experiences the following signs that should alert her:

general health worsens (may feel nauseous, diarrhea may occur at times, and the temperature may rise slightly);
mild discomfort in the lower abdomen, which intensifies after physical activity;
constant sensations of fullness and petrification in the abdominal cavity.

With an average degree of the syndrome, the above symptoms intensify and are joined by the following:

pain in the lower abdomen becomes more noticeable, worsening with sudden movements and spreading to the groin and sacrum;
the external genitalia may swell;
swelling also appears on the extremities (arms and legs);
weight may increase;
sensations of constant bloating and a feeling of fullness;
the daily volume of urine and the frequency of urges decrease;
presence of dysbacteriosis;
the patient complains of constant dizziness;
Visual disturbances may occur, which are manifested by the presence of “floaters” in front of the eyes.

The third degree of the syndrome is considered the most dangerous for a woman’s health. Accompanied by the following symptoms:

ascites develops, accompanied by severe swelling;
the daily urine output is significantly reduced;
a woman complains of constant fatigue, visual disturbances and headaches;
pronounced excruciating pain in the abdomen (in the form of distension from the inside), which does not go away after changing body position, but only spreads more intensely to the sacrum, groin and tailbone;
frequent vomiting;
presence of hypotension (low blood pressure);
a significant increase in body temperature;
swelling that spreads from the limbs throughout the body;
accumulation of fluid (hydrothorax);
the heart rhythm is disturbed, accompanied by difficulties in inhaling and exhaling.

Symptoms of hyperstimulation syndrome in most cases begin to appear 3-4 days after the first doses of hormonal drugs prescribed for women.

How is OHSS diagnosed?

If a woman has been prescribed hormonal drugs to stimulate ovulation and she has the first signs of feeling unwell, there is no need to wait and hope that everything will go away on its own. OHSS develops very quickly, causing serious complications.

First of all, the doctor analyzes the complaints: the presence of pain, poor health, existing swelling and nausea. The specialist should be informed:

about the history of previous diseases;
about the presence of bad habits;
possible hereditary factors in the patient;
the presence of similar cases in the past (have there been any attempts to stimulate ovulation that ended unsuccessfully).

This disease does not forgive mistakes in diagnosis. Neglect of the case and improper treatment threatens the woman with serious health complications. Therefore, to accurately diagnose OHSS, several methods are used simultaneously.

The general condition of the patient is examined to determine the severity of the case. The skin, which turns pale with OHSS, is examined. This condition is caused by disturbances in blood circulation. The limbs suffer the most (due to their distance from the heart muscle). During examinations of the cardiovascular system, tachycardia is determined, and the sounds of the heart muscle are muffled.

Many patients with OHSS develop edema of the vulva, extremities, and anterior abdominal wall.

The respiratory system is examined. Tachypnea is detected - rapid breathing, which does not depend on physical exertion. Hydrothorax may also occur - respiratory sounds are not heard, or auscultation - respiratory sounds are weakened.

When examining the abdominal cavity and its organs: due to the formation of ascites, the patient's abdomen is swollen, when pressed, a reaction to pain is manifested, which is present in all its departments (and especially in the ovarian region). The stomach may lag a little behind the act of breathing. On palpation of the abdominal cavity, enlarged ovaries are felt, as well as the liver, which begins to protrude under the costal arch.

Research of the urinary system. With OHSS, there are delays in urination, urine excreted is normal<1000 мл.

Studies of the central nervous system: consciousness, adequacy and contact of the patient. With the appearance of neurological symptoms, there may be a suspicion of thrombosis, which has formed in the vessels of the brain.

A high risk of intrauterine bleeding and (ovarian rupture) are a contraindication to a bimanual examination - a gynecological examination with the fingers. To assess the condition of the appendages and uterus, it is recommended to perform an ultrasound.

Blood and urine tests

Laboratory blood tests determine:

the norm of sex hormones present in the blood;
blood thickening (in the presence of OHSS);
how much the volume of the liquid part of the blood has decreased;
biochemical analysis will help identify signs of disorders in the functioning of the kidneys and liver.

Urine analysis will help determine its density, the concentration of protein present, as well as the rate of urine discharge.

Ultrasound will help to correctly assess the situation on the part of the ovaries (the size of their increase), detect the existing excess fluid in the abdominal cavity, and also refute or confirm the presence of pregnancy.

To determine the correct functioning of the heart, echocardiography and electrocardiography procedures are prescribed. And the X-ray procedure will help determine the presence of accumulated fluid in the chest and cavities in the heart area.

Since ovarian hyperstimulation occurs due to stimulation of ovulation, in addition you will need to consult a fertility specialist.

Consultation with other specialists

Due to the fact that ovarian hyperstimulation gives impetus to the development of pathologies associated with many body systems, consultation with a therapist will be required.

In cases of suspected development of thrombotic complications, it is recommended to consult a vascular surgeon. In case of critical and severe OHSS - consultation with an anesthesiologist-resuscitator. If there is severe hydrothorax, advice from a thoracic surgeon. His decision will determine whether or not to perform a puncture of the pleural cavity.

Features of the treatment of ovarian hyperstimulation

Treatment for OHSS depends on the complexity of the case. The doctor and the patient will have a choice to continue or interrupt the in vitro fertilization method.

In the case of a severe development of the pathology, the intake of drugs that are prescribed to stimulate ovulation is canceled. This means that infertility treatment will also be interrupted. It will be possible to repeat the ovulation stimulation procedure only from the next menstrual cycle, but the risk of re-development of OHSS increases significantly. In cases where fertilization has been successful, and the pathology is in the first stage, the specialist may advise you to continue infertility treatment, which is carried out at home. To do this, a woman must follow some rules:

avoid physical activity;
properly balance your diet (your doctor will tell you);
drink enough fluid;
wearing elastic underwear;
adhere to bed rest;
exclude sexual activity (sex can cause ovarian injury).

In addition to following these rules, painkillers are prescribed to a woman, as well as medicines that will help in the fight against nausea.

Severe and moderate stages of OHSS require urgent hospitalization. The patient should be under constant supervision of specialists. In stationary conditions, various solutions are administered intravenously:

drugs that reduce vascular permeability;
drugs that reduce the occurrence of blood clots;
antibiotics that reduce the risk of infectious processes;
protein nutritional preparations.

A procedure to remove ascitic fluid may also be necessary. For this procedure, a puncture is performed in the abdominal wall, which makes it possible to create an outflow of fluid. If fluid collects in the chest cavity, a puncture is made in the chest wall. In cases where the pathology has caused severe complications to the kidneys, the patient is prescribed hemodialysis (a method of extrarenal blood purification using special equipment).

Consequences of OHSS

Any stage of development of the syndrome can give complications in the form of: development of ascites, renal or heart failure, as well as hydrothorax. If you do not begin to control the course of the disease in a timely manner, ovarian hyperstimulation leads to the following complications (some of them threaten the patient’s life):

with the uncontrolled development of ascites, fluid in the abdominal cavity can reach volumes of 25 litres;
uncontrolled accumulation of fluid in the chest and abdominal cavity - acute heart failure;
accumulation of fluid in the chest and abdominal cavity - pulmonary function disorders, provoking acute respiratory failure;
development ;
necrosis or compression of the vessels that supply the ovaries - ovarian torsion;
thickening of the blood or a decrease in its volume - acute renal failure, provoked by impaired renal function;
apoplexy of one or both ovaries (their rupture with the risk of bleeding);
premature exhaustion of the ovaries, which threatens with final violations of hormonal and ovular function.

In cases of severe stage of ovarian hyperstimulation syndrome, the specialist reconsiders the strategy of infertility treatment.

How to avoid ovarian hyperstimulation during IVF

When ovarian hyperstimulation syndrome appears at the beginning of treatment, the woman refuses treatment, thinking to keep the pregnancy. But the most effective treatment for OHSS is avoidance of drugs that cause the syndrome. In order not to face the choice of preventing or maintaining pregnancy in the future, a woman needs to follow some recommendations of fertility doctors in order to prevent the disease. These guidelines include the following:

Before the ovulation stimulation procedure, you need to prepare in advance by passing a full examination of the whole body.
Compliance with a properly composed diet (foods rich in protein, as well as a sufficient daily intake of fluids drunk). You should avoid fatty, spicy and salty foods.
When planning a pregnancy, a woman needs to minimize stress factors and excessive physical activity.

The success of IVF will also depend on the specialist. Only he can choose the correct regimen and dosage for taking hormonal drugs that are prescribed to stimulate ovulation. Age, weight and previous gynecological diseases are taken into account.

One of the most common and most serious complications that arise during artificial insemination is ovarian hyperstimulation during IVF. Its main reason is excessive doses of drugs that are administered to stimulate ovulation. In the vast majority of cases, this condition can be successfully treated - but only if the necessary measures have been taken in time.

Under natural conditions, one egg matures in the female body in each cycle. With hormonal stimulation in the process, their number increases several times. This increases the chances of conception, but at the same time increases the production of estradiol, which results in thick blood, impaired capillary permeability, and the appearance of excess fluid.

OHSS can occur in any patient if the drugs and their dosage are selected incorrectly. However, there are several factors that contribute to its development:

polycystic ovary syndrome;
tendency to allergic reactions;
increased activity of estradiol;
the use of hCG drugs to support the luteal phase;
offensive;
external signs - more often the syndrome develops in thin women under 35 with blond hair.

Symptoms

One of the first signs of OHSS is abdominal heaviness and bloating.

Most often, signs of hyperstimulation appear after embryo transfer, less often - immediately before it. It is extremely rare that they are detected even during stimulation. The strength of their manifestation depends on the degree of development of the syndrome:

Mild degree: slight swelling, pain as during menstruation, heaviness in the abdomen, frequent urination. An ultrasound shows that the ovaries increase in size to 6 centimeters.
Moderate degree: bloating, increased swelling, weight gain, vomiting and nausea. The size of the ovaries is 8-12 cm.
Severe degree: noticeable increase in abdominal volume, vomiting, hypotension, difficulty breathing, interruptions in heart function. In addition, signs of ascites are observed, the functioning of the liver is disrupted, and fluid accumulation in the pleural cavity is recorded. The ovaries are enlarged by more than 12 cm.

The patient describes some of the symptoms in her reviews:

Anya: “About a week after the transfer, I began to experience severe itching, which lasted for 15 days. At the same time, liver enzymes were 10 times higher than normal; I generally keep quiet about hormones. A month after the support was cancelled, everything returned to normal, there is no water anywhere, although I lost a little weight.”

Natasha: “I had very severe hypera. A lot of fluid has accumulated - 10 liters in the stomach and 1.5 liters in each lung. I hardly ate for a month, couldn’t sleep, and screamed in pain. I spent almost a whole month on a drip, and the pregnancy eventually froze in the eighth week. The liquid was completely gone only after four months.”

Ira:“It all started on the sixth day after the transfer. At first it was tolerable, I followed a diet and drank. Then it became so twisted that an ambulance was called and surgery was performed at the hospital. It turned out that a huge cyst had formed, which caused the ovary to twist.”

How to treat?

The basis of treatment for mild hyperstimulation is a high-protein diet and plenty of fluids.

Methods for treating ovarian hyperstimulation afterward depend on the severity. In all cases, diet is important; in the first degree, it becomes the leading method of treatment, which is carried out at home. Diet for OHSS and lifestyle suggest:

drinking plenty of fluids, except alcohol and carbonated drinks;
eating protein foods;
priority – lean white meat, lean veal, boiled fish;
a balanced diet including cereals, herbs, and nuts in the menu;
refusal of physical activity and sexual relations.

If OHSS has developed to a moderate or severe degree, treatment is carried out in a hospital. Typically, medications are used:

designed to reduce vascular permeability;
aimed at preventing the development of thromboembolism;
designed to adjust the protein and electrolyte composition of plasma.

In severe cases, treatment of ascites by pumping out fluid from the abdominal cavity and surgical intervention may be indicated - for example, if cyst ruptures and internal bleeding occur. In the reviews, patients talk about the methods of treatment prescribed to them:

Maria:“You need to drink a lot of water and eat protein foods. In no case anything salty and no diuretics! You should also not eat foods that can cause bloating - grapes, brown bread, legumes, cabbage. Fish and meat are allowed without restrictions.”

Kate:“It started after the puncture - in the evening my stomach hurt, it was difficult to breathe, I couldn’t stand in an upright position. The next day I was admitted to the hospital and given Refortan drips. But in the end, the embryos were sent for cryo, and the transfer was done only after two cycles.”

Julia: “My hypera started early, two days after the puncture. They put me on IV drips right away, then I lay under IV drips for another two days for six hours at a time. For intestinal problems, which almost everyone has, I drank Duphalac and Hilak Forte.”

Eve: “I was covered the next day after the puncture, and it lasted for about a week. The abdomen was huge, they wanted to puncture it, but everything was done with IVs - they put Refortan and albumin. The IVs only made it feel worse; it felt like my stomach was going to burst. But in fact, they are necessary because it is physically impossible to eat that much protein.”

Possible consequences

With OHSS it occurs almost twice as often. However, if pregnancy does occur after IVF in the presence of hyperstimulation, then the syndrome significantly complicates its course, especially in the first trimester. In addition, in severe cases the following complications may occur:

ascites;
respiratory failure due to the appearance of fluid in the chest cavity;
renal failure;
ovarian rupture;
ovarian torsion followed by necrosis;
premature ovarian failure.

How to avoid overstimulation?

The main measure to prevent ovarian hyperstimulation during IVF is an individual approach from the doctor for the correct selection of drugs and their dosage. If symptoms have already begun to manifest themselves, the following measures can help prevent OHSS:

Cancellation of hCG injections.
aspiration of follicles.
Reducing the dosage of gonadotropic drugs.
Cancellation of embryo transfers and their .

In addition, in patient reviews, patients often mention the drug Dostinex and other drugs that are prescribed in small doses for prevention:

Yana: “From the seventh day of stimulation, I took Dostinex as prescribed to prevent hyperstimulation.”

Kate: “I had every chance of getting OHSS, because the cause of infertility was the male factor, and my body worked well even without stimulation. Besides, I'm 30 years old, small and fair-haired. To avoid all this, I took Dostinex. I know that some people do not tolerate it very well; they experience nausea and dizziness. But I didn’t experience anything like that.”

Vika: “The doctor advised me to take protein capsules for two weeks after the puncture, 80 grams per day, it is sold in pharmacies. It helped me: they took as many as 40 cells, I was very afraid of hyperthermia, but everything worked out.

What is hyperstimulation syndrome and how to avoid it?

It is not recommended to plan a second attempt at in vitro fertilization within 2-3 months after hyperstimulation. This time is necessary for hormonal levels to be restored and ovarian function to normalize. In difficult cases, if complications cannot be avoided, preparation for a subsequent pregnancy should be carried out under the strict supervision of a doctor and only after the consequences have been eliminated.

Ovarian hyperstimulation is a complication of the IVF procedure. It manifests itself as a syndrome and develops mildly in most patients. The danger is the severe course of such a complication, which can lead to infertility, renal and hepatic failure, and heart attack. Therefore, it is important to identify and fix the problem in a timely manner.

Symptoms and development

Early ovarian hyperstimulation syndrome has symptoms that do not cause much concern to a woman: discomfort, heaviness and fullness in the lower abdomen are felt, and sometimes mild soreness. The ovaries become larger, fluid accumulates in the abdomen, and blood circulation is impaired. Some women pay attention to an increase in waist size, slight weight gain, and slight swelling.

The transition of OHSS to a more severe stage is accompanied by increased pain in the lower abdomen, increased swelling and volume of the abdomen. Fluid accumulation occurs not only in the abdominal cavity, but also in the pleural and pericardial cavity. Shortness of breath, hypotension, and tachycardia develop. Most of the time the woman is in bed in a semi-sitting position. Nausea, vomiting, loose stools appear, and gases accumulate.

Ovarian hyperstimulation with such symptoms can lead to serious consequences; urgent hospitalization, comprehensive examination and treatment are required.

Diagnostics

Treatment of ovarian hypersitmulation syndrome is prescribed based on diagnostic data.

It includes:

studying the patient’s complaints and medical history;
general and gynecological examination, including palpation of the abdomen;
Ultrasound of the pelvic and abdominal organs;
blood test (general, biochemical, hormones);
Analysis of urine;
ECG and ultrasound of the heart;
chest x-ray.

The list of examinations can be shortened or increased, depending on the clinical picture of the syndrome. Sometimes a consultation with specialized specialists is prescribed: pulmonologist, cardiologist, gastroenterologist.

Treatment

Mild ovarian hyperstimulation can be treated at home . It is necessary to drink as much as possible (except for carbonated and alcoholic drinks), eat a nutritious and balanced diet, and abstain from sexual intercourse and physical activity for several weeks. To monitor whether the syndrome is developing, urine output and weight changes should be assessed daily.

Moderate and severe degrees of OHSS are treated in a hospital setting. Drugs are prescribed that reduce the permeability of vascular walls and drugs to prevent thromboembolism. For complications - antibiotics and hemodialysis. To improve blood composition, plasmapheresis sessions are performed.

In severe ovarian hyperstimulation syndrome, ascitic fluid is punctured , surgery (if there is internal bleeding).

Complications

Complications of ovarian hyperstimulation syndrome include:

development of ascites - accumulation of a large volume of fluid in the abdominal cavity;
acute respiratory and/or heart failure due to fluid accumulation around organs;
acute renal failure due to a decrease in blood volume and an increase in its density;
ovarian ruptures, bleeding;
ovarian torsion.

Consequences

The consequences of ovarian hyperstimulation depend on how timely medical care was provided. The likelihood of their development increases in proportion to the severity of the syndrome.

The most serious consequence is premature ovarian failure syndrome. Due to their artificial simulation, functioning stops prematurely, before the onset of menopause. The maturation of eggs stops, menstruation is disturbed and disappears. If both ovaries are exhausted, the woman becomes infertile.

Prevention

How to avoid the development of ovarian hyperstimulation syndrome during IVF?

The main preventive measures are as follows:

cryopreservation of cultured embryos until the onset of the natural menstrual cycle (not stimulated by drugs);
cancellation or reduction of the dose of stimulant drugs;
constant monitoring of estrogen concentration in the IVF cycle;
careful monitoring of the patient's condition by the doctor.

To prevent the transition of mild OHSS to more severe ones, it is necessary to inform the doctor about even minor changes in well-being. This is especially important if fertilization was successful and pregnancy began to develop.

Ovarian hyperstimulation syndrome occurs due to the use of hormonal drugs in the initial stages of IVF. It is diagnosed to a mild degree in most patients and can be eliminated in a short time, sometimes even without the use of medications.

When pregnancy occurs, the risk of increased OHSS is higher, so medical supervision is required. In moderate and severe cases, treatment is carried out in a hospital.

Useful video about OHSS

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Ovarian hyperstimulation is a pathological reaction of a woman’s body to 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) poses a real threat to a woman’s life, especially when provided with 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 dilation of 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, the maturation of not one, but two or three and sometimes even more than ten eggs often occurs. It is also impossible to predict how sensitive a woman is to all medications used. As a result, almost the same thing happens as in the norm, but in a different volume. 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, enters the abdominal cavity. This leads to pain, 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.
Deficiency in body weight. 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.

With a 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 the accumulation of fluid in the pleural cavity and the creation of 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 a mild degree of OHSS must be differentiated from the threat of miscarriage. Nausea, vomiting, weakness, nagging pain in the 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 her lower abdomen, and she may not even seek medical help.
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. With this degree of OHSS, treatment is carried out only in an intensive care unit.

Based on the time of occurrence, the following types are distinguished: 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.
A general examination and a special (gynecological) examination are carried out. 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.
It is mandatory to perform general blood and urine tests, 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, if complications occur (rupture or torsion of the ovary), emergency surgical assistance is necessary. 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” in order to reduce the pressure on the 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 turn into 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.