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

Today, ovarian hyperstimulation syndrome 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. Most importantly, if you find any similar symptoms, you need to contact a specialist as soon as possible, otherwise the problem can cause great harm to the body.

What is OHSS

OHSS (ovarian hyperstimulation syndrome) is a serious complication that can occur after an IVF procedure. The main reason 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 in the uterus or after implantation.

The reasons

Although modern medicine has reached a fairly high level, no one can yet determine the possibility of ovarian hyperstimulation in a particular patient after the procedure. The body of each woman will react to changes in her own way, so preventing the problem right away will be quite difficult.

But even despite this, doctors have approved 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 blond hair color up to 36 years old (usually such patients are not inclined to be overweight);
• transferred;
• excessive activity of estradiol in the circulatory system;
• allergic reactions to drugs that have been confirmed recently.

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

• significant errors in the dosage of drugs;
• too low body weight of a woman (a tendency to anorexia and the like);
• a sudden negative reaction to certain hormonal drugs;
• similar problems in the past.

Symptoms

When observing the factors listed below, it can be said with certainty that ovarian hyperstimulation syndrome develops. Symptoms will help to verify 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, pulling and sudden pain in the lower abdomen. The patient has a significant increase in urination.
2. At an average level of severity, nausea and vomiting are observed first, and then diarrhea, bloating, and an increase in body weight become noticeable.
3. A severe degree entails more serious changes - frequent shortness of breath, a change in heartbeat. The patient may have hypotension, the abdomen is too enlarged.

Diagnostics

Only after the necessary diagnosis has been carried out will it become clear how to treat ovarian hyperstimulation syndrome in a particular patient. After all, the body of each person reacts to certain drugs in different ways.

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

Standard diagnostics is based on the following factors:

• Analysis of all patient complaints. For example, with a sharp deterioration in well-being, she has frequent abdominal pain for no specific reason, alternating nausea and vomiting.
• Mandatory history of the disease, if the symptoms began to appear after the release of the egg from the ovary.
• Life history analysis. Previously transferred diseases, the presence of various bad habits, similar cases of the development of the disease after the IVF procedure are taken into account.
• The results of a general examination by a gynecologist, palpation of the abdomen (the ovaries must be palpated).
• An ultrasound scan will accurately show the presence of the fetus, and will also make it possible to detect excess fluid that has accumulated in the abdominal cavity.
• Thorough laboratory analysis of blood. An excessive amount of sex hormones can be detected here, a general analysis will show the presence of areas of condensed blood, and a biochemical analysis will show barely noticeable signs of changes in the functioning of the kidneys.
• Urinalysis (during the conduction, a decrease in urine, an increase in density, as well as the excretion of protein with urine will be seen).
• Electrocardiography, and then ultrasound radiation of the heart (this will detect some abnormalities in cardiac work).
• X-rays of the chest will show the presence of fluid in the internal cavity of the chest, as well as in the pericardial sac.

Varieties

In total, two types of syndrome are distinguished in medicine:

1. Early. It develops immediately after ovulation. In the event that pregnancy does not occur in any way, then this means the withdrawal 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 rather difficult.

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

1. Light. Not too noticeable deterioration in well-being, some discomfort and swelling in the abdomen.
2. Average. More noticeable pain in the abdomen, deterioration and swelling. There is also an increased feeling of nausea and vomiting. And fluid begins to accumulate in the abdominal cavity.
3. Heavy. A strong deterioration in a person’s condition, weakness, very sharp pains in the abdomen are felt. The pressure drops, shortness of breath appears due to the accumulated fluid.

Treatment

In the case of a mild form of ovarian hyperstimulation syndrome (with IVF), treatment implies only as changes in the standard diet:

• You need to make a schedule for the use of fluid 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 avoided.
• In food, eat not too fatty meat, vegetables and fish in a boiled state.
• Physical activity should not be large, excessive overvoltage should also be avoided.

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

Complications

Ovarian hyperstimulation syndrome can lead to some problems that are also harmful to 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 at its normal rhythm);
• exhaustion of two ovaries prematurely.

How to avoid the problem

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

1. Cancel the introduction of a certain ovulatory dose of a particular drug that is used during the procedure.
2. For a while, 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 such a plan can be found on various forums on the Internet, but still, to save health, it’s not enough just to listen to other people. You need to be aware of 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 baby 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. The dosage of any medication must be checked.
2. The dose of gonadotropins can be reduced if this does not interfere with the desired result after the procedure. With a successful dose reduction, you can be almost one hundred percent sure that the disease has already been avoided.
3. After passing all the tests and passing the required procedures, the doctor can conclude that the embryo can be frozen. This will also play an important role in avoiding the problem.

Who is at risk of illness

It is impossible to predict exactly who is at risk of developing the disease. But there are the most frequent cases in which ovarian hyperstimulation syndrome manifested itself. Among them is a small body weight of a girl or woman who decided to undergo the procedure, as well as a patient with cystosis or polycystic ovaries (this can be a disease both in the present and already suffered in the past).

Medicine at the modern level has achieved many successes, but still it cannot reach ideal results yet. Therefore, before the procedure, no doctor can guarantee the absence of disease after IVF. But if you notice its development in the early stages, then the treatment will not be too long.

In IVF, the ovaries are stimulated with hormonal drugs to increase the number of oocytes produced. Artificial stimulation of superovulation is especially useful for ovarian dysfunction, when the female body does not naturally produce an egg. The stimulation procedure may be accompanied by unpleasant physical sensations. In 5% of cases, a very unpleasant complication occurs - ovarian hyperstimulation.

Ultrasound image of enlarged ovaries due to stimulation of superovulation during IVF.

What is ovarian hyperstimulation

Testicular hyperstimulation syndrome (OHSS) is one of the most unpleasant and common consequences of ovulation stimulation when planning IVF. All women need to know about the features, signs and consequences of such a phenomenon. This is especially true for those women who are counting on IVF or already have an unsuccessful experience of artificial insemination, but do not refuse repeated protocols.

Hyperstimulation is a pathological condition of the female reproductive system, in which the gonads increase as a result of a significant growth of several follicles.

With the development of such a pathology, depending on the severity of its course, these organs can increase several times. In medicine, there are even cases when the follicles reached a size of 20 cm (at a rate of 3 cm).

Hyperstimulation syndrome occurs in women taking stimulant hormonal drugs (gonadotropins). There are also isolated cases when hyperstimulated ovaries are observed in. More often, such a pathology develops in. In this case, hormone therapy is simply indispensable.

In this video, a gynecologist-reproductologist talks in detail about ovarian hyperstimulation syndrome:

Signs of OHSS

Pathology can be recognized by characteristic symptoms. Hyperstimulated ovaries make themselves felt by the following symptoms and unpleasant manifestations:

• "Inflated" abdomen - is a consequence of the development of ascites, which is characterized by the accumulation of fluid in the peritoneal cavity;
• pain in the lower abdomen;
• difficulty breathing - occurs against the background of fluid pressure on the diaphragm;
• nausea and vomiting, sometimes even diarrhea;
• accumulation of fluid in the lower part of the body;
• severe swelling of the limbs, as well as the peritoneal area;
• lowering blood pressure;
• excretion of insufficient amount of urine.

Ovarian hyperstimulation can be of two types:

• early - occurs after ovarian stimulation as a result of the use of drugs based on hCG;
• late - the pathology develops on the 9th day after the attachment of the embryo against the background of the growth of hCG and the placenta.

Depending on the severity of the course of the pathology, there is such a classification of the degrees of hyperstimulation:

1. Light. A woman is concerned about moderate pain in the abdomen, a feeling of "bloating" and heaviness. The ovaries are 8 cm in size.
2. Average. Pain of moderate intensity, nausea or vomiting occurs, an accumulation of fluid in the peritoneum is detected on ultrasound, the ovaries increase to 12 cm.
3. Heavy. A strong increase in the abdomen as a result of the development of ascites, urinary retention, ovaries more than 12 cm. According to statistics, this degree of OHSS develops in 0.3-8% of cases.
4. Critical. A very dangerous condition that requires immediate medical attention. Blood pressure is very low. Rapid pulse, breathing becomes very difficult. Urine is allocated very little, up to 1 liter.

This is how ovarian enlargement occurs during stimulation in the IVF protocol. On the right is an ovarian hyperovulation. Middle of the norm. On the left, the ovary before the start of stimulation with hormonal drugs.

Pregnancy with ovarian hyperstimulation

The condition of a woman, after ovarian puncture and their hyperstimulation, can worsen significantly. In place of the former follicles, experts often notice the formation of a corpus luteum, then the replanting of a fetal egg into the uterine cavity is not recommended. However, as medical practice shows, in some cases, at the discretion of the doctor, the protocol ends with successful implantation and childbirth.

With a pronounced stage of hyperstimulation, pregnancy is complicated by the production of an increased level of hCG. It is this hormone that is the trigger in the development of hyperstimulated ovaries, without which this pathology does not occur. Considering such serious complications in preparation for IVF, it is important to monitor the growth of follicles, their number and choose the right ovulation trigger - a hormonal drug for follicle growth. Medicines that are prescribed before ovarian puncture are necessary for the maturation of eggs, they contain chorionic gonadotropin.

It is very dangerous to get pregnant during OHSS! If fertilization did occur, the threat of miscarriage remains for the entire period of gestation. Strict medical supervision is required.

Ovarian hyperstimulation after follicle puncture

Hyperstimulation develops as a response to the introduction of an ovulation trigger (hormonal drugs) into the female body. Sometimes OHSS occurs after follicle puncture. This is a dangerous phenomenon, which in most cases requires adjustments to the in vitro fertilization protocol scheme.

In case of hyperstimulation after a puncture, experts recommend postponing the embryo transfer and freezing the fertilized eggs (embryos) in order to carry out fertilization in a natural cycle or in. This is the most correct decision, since a woman will more easily endure the hyperstimulation that has occurred and her body will be able to recover normally before the embryo is replanted.

Ovarian hyperstimulation syndrome after puncture is characterized by the following symptoms:

• lower abdominal pain;
• increase in body temperature up to 38 degrees;
• swelling of the body, including the development of ascites - accumulation of fluid in the peritoneal cavity;
• difficulty urinating and a decrease in the amount of urine excreted;
• nausea, vomiting, diarrhea.

OHSS can develop after follicle puncture. In this case, it is better to transfer the embryo transfer.

Common and most dangerous consequences of OHSS

The resulting ovarian hyperstimulation syndrome during IVF does not go unnoticed for a woman. The consequences, unfortunately, remain. Among the consequences of the negative reaction of the female body to the active work of the reproductive system, such adverse changes are more often observed:

1. Ascites. This term in medicine is called the accumulation of fluid in the pleural cavities of the peritoneum. The complication is manifested by an increase in the size of the abdomen, shortness of breath, a feeling of heaviness. The maximum amount of fluid that accumulates in the body as a result of the development of ascites can reach 25 liters.
2. Torsion of the ovaries. Against the background of hyperstimulated ovaries, their complete or partial torsion may occur. Such a consequence is rare, but it definitely requires surgical intervention.
3. Rupture of an ovarian cyst (apoplexy). In such a pathological condition, hemorrhage occurs in the tissue of a hyperstimulated ovary, followed by a violation of its integrity, the destruction of the cyst capsule and the release of its contents into the abdominal cavity.
4. Follicular cysts. They are benign formations resulting from a violation of ovulation processes in the female body. The size of the follicular cyst usually does not exceed 10 cm. As a rule, with the development of a follicular cyst, no symptoms bother a woman. She often learns about the development of this unpleasant pathology during an examination by a gynecologist or during an ultrasound scan. If the cyst does not exceed 5-6 cm, its treatment is not required, it resolves on its own during the next menstruation. In cases where the neoplasm continues to grow, reaches a size of more than 6 cm, drug hormone therapy is prescribed. And sometimes you can not do without surgery.
5. Renal failure. With ovarian hyperstimulation, disturbances occur in the functioning of the urinary system. There is a decrease in diuresis - a decrease in the amount of urine excreted, pain in the lumbar region of the back, general weakness of the body, nausea, vomiting, dizziness.
6. Liver failure. Pathology is detected as a result of a biochemical blood test. In the later stages of the development of a violation in the liver, symptoms such as jaundice, fever, sudden weight loss, apathy, speech impairment, hand tremors can be observed.

Is it possible to avoid hyperstimulation during IVF?

It is extremely rare to completely avoid the risk of developing ovarian hyperstimulation during artificial insemination, it is almost impossible. The likelihood of developing OHSS is purely individual. Considering the possible consequences of stimulation, doctors are always trying to create conditions for their patients in which the risk of developing hyperstimulation syndrome will be reduced.

No one can fully guarantee the absence of OHSS during IVF. This is one of the main disadvantages of in vitro fertilization, which should be known to all expectant mothers who applied to the ART clinic.

In the centers of reproduction, before starting the protocol, the following preventive measures are taken to reduce the likelihood of OHSS:

• hormonal control;
• conducting ultrasound and folliculometry when stimulating superovulation;
• the introduction of minimally low doses of stimulant drugs;
• the use of drugs that do not contain hCG;
• delayed introduction of an ovulation trigger;
• cancellation of embryo transfer "until better times".

According to medical practice, not all women are equally susceptible to the development of pathology during IVF. In the risk zone for the development of hyperstimulated ovaries are:

• Young patients under the age of 35.
• Patients with low body weight (less than 47 kg).
• Expectant mothers with previously diagnosed polycystic ovary syndrome.
• Women with a burdened allergic history.

How is the diagnosis made?

The diagnosis of ovarian hyperstimulation is made on the basis of blood pressure, measurement of daily diuresis, volumes of the abdominal circumference. A laboratory study is mandatory - a general and biochemical blood test, a hemostasiogram. At the stage of diagnosing pathology, ultrasound of the pelvis, peritoneum and pleural cavities is also performed.

Treatment of OHSS

There is no specific treatment for ovarian hyperstimulation. Therapy is aimed at eliminating deviations in the work of internal organs. For example, for OHSS during pregnancy, treatment is based on the use of hormonal maintenance drugs.

Treatment continues until the clinical indications return to normal and all symptoms disappear.

Mild treatment

If a mild degree of hyperstimulated ovaries is diagnosed, treatment is usually carried out on an outpatient basis (the patient is at home and visits the doctor at the appointed time to monitor the treatment process). At this stage of the disease, strict bed rest and complete rest are necessary. It is important to avoid stressful situations. In addition, you should follow a protein diet. Salt intake with such a diet is minimized. Alcohol and smoking are completely prohibited throughout the recovery period.

Moderate treatment

Treatment in this case is possible exclusively in the hospital. The fact is that the likelihood of developing complications with ovarian hyperstimulation is extremely high. Therefore, constant monitoring of the patient is required. Doctors should monitor the patient's fluid and electrolyte balance. It is very important to monitor the indicators of blood tests and the work of internal organs.

What is the usual treatment for OHSS?

1. With moderate or severe ovarian hyperstimulation syndrome, the use of medications is mandatory. The action of drugs should be aimed at normalizing the amount of circulating blood. The drugs should restore renal filtration. It is also necessary to bring the density of the patient's blood back to normal. For these purposes, the patient is given saline solutions drip or intravenously.
2. If there is a danger of an increase in the inflammatory process, anti-inflammatory drugs are prescribed. Often the treatment of OHSS is supplemented with antipyretic and analgesic drugs. These can be Ortofen, Nurofen or Paracetamol tablets. If the pills do not help, drugs can be administered intramuscularly.
3. Particular attention, in the treatment of ovarian hyperstimulation, is given to preventive actions against thrombosis. For this, the patient is prescribed Dalteparin or Fraxiparin.
4. To prevent infection of the pelvic organs and abdominal cavity, antibacterial therapy with broad-spectrum antibiotics is carried out.
5. If the patient is pregnant, appropriate hormonal support with progesterone will be mandatory. In addition to hormone therapy, antispasmodics, vitamin complexes and sedatives are prescribed. Sexual intercourse for the entire duration of the treatment of OHSS is completely prohibited.

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Ovarian hyperstimulation is a pathological reaction of a woman's body to a specific hormonal treatment before or after IVF. Statistical data on the occurrence of this pathology vary from 0.5 to 30%. This difference 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 unskilled care is provided. Why and for whom does the condition arise, what can it lead to and how to deal with it correctly?

Read in this article

Causes of Ovarian Hyperstimulation Syndrome

The hyperstimulation syndrome can occur both during the maturation and ovulation of one egg, and several, single cases of the appearance of OHSS in their own cycle without any external influences are described.

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

With artificial stimulation, 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 the drugs 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 may react in the same way. Therefore, often a woman needs resuscitation.

Risk factors for developing OHSS

It is impossible to predict the likelihood of developing ovarian hyperstimulation syndrome. But they distinguish a certain risk group among all girls planning a 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 presumed active eggs in practice is 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 a small weight, even a relatively small plasma effusion will lead to serious consequences.
• Use as a stimulation of hCG or gonadotropic hormones under a long protocol.
• Multiple pregnancy.
• If a girl has ever had OHSS, then the severity of symptoms during the next IVF in most cases is 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, a 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, already during pregnancy or after embryo transfer. Symptoms may include the following:

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

If the pregnancy is fixed, then a mild degree of OHSS must be differentiated from the threat of termination. Nausea, vomiting, weakness, pulling pains 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 fights in the lower abdomen, she may not even seek medical help.
• Stages 3 and 4 are considered moderate. The ovaries can grow up to 12 cm, and ascites (fluid in the abdominal cavity), vomiting and nausea, and less often diarrhea, are added to all previous symptoms.
• 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 (decrease in blood volume): low blood pressure, confusion, impaired kidney 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 whole body (anasarca) and other symptoms may occur. With this degree of OHSS, treatment is carried out only in the intensive care unit.

According to 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 ovarian puncture for egg collection. 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 an IVF center. Therefore, the diagnosis and treatment have to deal with general practitioners. When making a diagnosis, the following is done:

• An anamnesis is collected, in which it becomes known when IVF was performed, what drugs were stimulated, what kind of attempt it was, etc.
• A general examination and a special (gynecological) examination are carried out. As a result, the doctor prescribes an additional examination and determines the severity of OHSS.
• Ultrasound of the small pelvis and abdominal cavity is performed, and signs of ascites, etc. can be detected.
• Ultrasound of the heart, pleural cavity, and X-ray of the lungs can detect the accumulation of fluid in these places.
• If necessary, an ECG and some other research methods are performed.
• It is mandatory to perform general blood and urine tests, a biochemical profile and others.

Treatment of ovarian hyperstimulation syndrome

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

• Bed rest.
• Sufficient fluid intake in the body - drinking plenty of fluids or intravenous infusions of solutions. And mostly not the usual "water" - physiological solution, but special ones, for example, HES (hydroxyethylene starch), etc. The latter do not so quickly sweat again in the body cavity.
• Drugs to reduce the permeability of the vascular wall. It also avoids blood clotting 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 pressure on the internal organs and somehow temporarily reduce the severity of the process. After the evacuation of the fluid, it immediately begins to re-penetrate there, if adequate basic symptomatic treatment is not carried out.
• If acute renal failure occurs, hemodialysis may be temporarily used.
• Antibacterial drugs are prescribed to prevent infection in moderate and severe OHSS.
• If OHSS develops already against the background of pregnancy, additionally, preservation therapy (antispasmodics, hormonal, and others) is prescribed.

In any case, treatment should 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 can occur with OHSS

Mild to moderate OHSS resolves without sequelae in most cases. But they can turn into severe forms, and also have an unpredictable course. The most common complications encountered are:

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

Prevention of ovarian hyperstimulation

Prevention of development is as follows:

• It is necessary to plan pregnancy and undergo a thorough examination the day before.
• When choosing drugs for stimulation, one should take into account all previous IVF attempts, the reaction of the woman's body to the drugs.
• At the time of planning, the girl needs to observe mental and physical peace, eat right and balanced, drink enough fluids.

Ovarian hyperstimulation syndrome is a serious condition that requires a competent approach and individual treatment. Today it is not so common, but it can still pose a threat to life. In order to avoid this, one should carefully approach the schemes and methods of stimulation, observe the woman's reaction.

For many women suffering from infertility, IVF is a life-saving procedure that gives hope for the birth of a long-awaited baby. The patient's own eggs are used, which, after fertilization "in vitro", are transferred to the uterus so that the woman can bear the fetus. To obtain eggs, it is necessary to stimulate the maturation of the follicles so that ovulation occurs. There is a risk of ovarian hyperstimulation. It is difficult to predict its occurrence, but the consequences can be eliminated by timely treatment.

Content:

Indications for stimulation

A common cause of infertility in women is ovarian dysfunction. In this case, the menstrual cycle proceeds without ovulation. As a result of hormonal disorders, follicles with eggs do not mature, and the second (luteal) phase of the cycle is absent. In this case, a woman cannot become pregnant.

Indications for stimulation are:

• treatment to restore the normal ovulatory cycle in women who are able to become pregnant naturally;
• preparation for IVF, that is, the artificial cultivation of several (about 10-20) follicles, of which some are planted in the uterus, and some are frozen in case of a second attempt, if the first one is unsuccessful;
• egg donation.

With the help of special preparations, it is possible to regulate the production of female sex hormones and achieve the maturation of full-fledged follicles. In this case, the cycle will cease to be anovulatory. In order for conception to occur, the egg must be in the fallopian tube, where sperm are located after intercourse. If the penetration of the egg into the uterus in a natural way is impossible (for example, due to obstruction of the tubes), then the follicles are removed from the body, and artificial fertilization of the eggs is performed. Stimulation takes place with the help of hormonal preparations with a high content of estrogens.

What is hyperstimulation syndrome

The tolerance of hormonal drugs is individual for each woman. Even careful selection of the drug cannot guarantee the absence of complications, including ovarian hyperstimulation syndrome (OHSS). This pathological condition is a reaction of the body to interference in physiological processes and has a number of negative manifestations.

With excessive stimulation, the maturation of the follicles is accompanied by an increased production of female sex hormones. The level of estrogen is several times higher than normal. This leads to an increase in the size of the ovaries, the appearance of cysts on them, and sometimes to the rupture of the ovarian membrane.

Under the influence of hormones, biologically active substances are formed that dilate blood vessels. At the same time, their walls become thin, easily pass liquids (blood, lymph, plasma). Fluid accumulates in the abdominal cavity (ascites occurs), as well as in the pleura (hydrothorax), in the pericardial sac (hydropericardium).

Video: Negative effects of ovarian stimulation. What signs should alert

Complications and consequences

Overstimulation can have dangerous consequences. With the maturation of several follicles, there is an increased likelihood that at least one egg will linger in the fallopian tube and the embryo will begin to develop. That is, an ectopic pregnancy occurs.

The accumulation of fluid in the pericardial sac makes it difficult for the heart to contract, which can lead to acute heart failure. Ascites appears, the abdominal cavity is filled with fluid that seeps through the thinned vessels. In this case, there is a decrease in blood volume and its thickening, which causes disruption of the kidneys. The appearance of fluid in the respiratory area leads to shortness of breath, can cause suffocation.

There is an increased likelihood of torsion of the ovary or cysts located on it. This process is associated with impaired blood supply, tissue necrosis. Rupture of the ovary after hyperstimulation (apoplexy) leads to deadly internal bleeding.

Forms of OHSS

There are 2 forms of ovarian overstimulation syndrome.

The early syndrome manifests itself in the second phase of the cycle. If fertilization does not occur and pregnancy does not occur, then the symptoms that appear, as a rule, disappear after the start of the next menstruation.

Late syndrome manifests itself when pregnancy occurs, the embryo is fixed in the wall of the uterus. At the same time, the symptoms of hyperstimulation appear at about 5-12 weeks and significantly complicate the course of pregnancy, increasing toxicosis.

Causes of OHSS

Ovarian hyperstimulation occurs as a result of taking strong hormonal drugs, the body's reaction to which is unpredictable. Factors that increase the likelihood of hyperstimulation syndrome are:

• the presence of polycystic;
• excess of the norm of estradiol in the blood;
• the existence of a genetic predisposition to the occurrence of OHSS syndrome;
• increased sensitivity of ovarian cells to the effects of drugs used for stimulation;
• taking drugs in an overdose (violation of the doctor's prescriptions).

Warning: At an increased risk of ovarian hyperstimulation are women under the age of 35 who have a small body weight. Often this pathology recurs in those who have been treated with hormonal drugs before and in whom hyperstimulation has already been observed.

Video: Factors that increase the risk of OHSS

Symptoms of overstimulation

The main reason for the appearance of unpleasant and dangerous symptoms is a significant increase in the size of the ovaries with their excessive stimulation.

The first sign of the onset of a pathological syndrome is the appearance of heaviness and pain in the abdomen. The accumulation of fluid in the abdominal cavity leads to an increase in waist circumference by several centimeters within 1-2 days from the time of the procedure. Added body weight.

The severity of the pathology

After excessive stimulation, symptoms of varying severity appear.

Easy degree. The state of health worsens slightly, edema occurs, and a violation of the intestines is manifested.

Average degree. The patient suffers from nausea and vomiting. Feeling pain in the abdomen due to the accumulation of fluid in the abdominal cavity.

Severe degree ovarian hyperstimulation. Periodically, severe vomiting occurs, the volume of the abdomen increases, severe pain appears in it. Blood pressure drops, shortness of breath and heart failure appear.

critical degree. The patient may die due to thromboembolism, renal failure, acute heart failure and other severe consequences of hormonal ovarian stimulation.

With a mild form of ovarian hyperstimulation, only a slight malaise is felt, abdominal pain is comparable to sensations during menstruation. Increased urination. Legs swell. The patient's health will be restored in 2-3 weeks. No treatment is required. The doctor who performed the stimulation monitors the condition of the woman in order to take urgent measures in case of deterioration.

With moderate OHSS, symptoms worsen. The diameter of these organs increases to 8-12 cm. The abdomen swells, flatulence, nausea, and vomiting occur. There is no appetite. Despite this, body weight increases due to the accumulation of fluid in the abdomen and an increase in the size of the appendages. There is dizziness, weakness, swelling of the limbs.

With severe ovarian hyperstimulation syndrome, the patient has cardiac arrhythmia, it is difficult for her to breathe. The belly grows even more. There are severe pains that radiate to the groin area. The body temperature rises. The size of the ovaries exceeds 12 cm. Squeezing of the bladder leads to frequent and difficult urination. Blood pressure drops. Edema appears all over the body.

There are complications from which a woman can die if an urgent operation is not performed.

Diagnostics

The occurrence of ovarian hyperstimulation syndrome is diagnosed on the basis of data obtained by conducting urine and blood tests, as well as instrumental examination of the state of various organs:

• a general blood test is performed to determine the number of platelets and coagulability;
• according to the results of a biochemical blood test, the functioning of the kidneys and liver is judged;
• a blood test for hormones shows the blood levels of estrogens and progesterone;
• urine analysis allows you to find out how the kidneys work (the presence of protein, the specific gravity of urine is determined, the volume of fluid released from the body is measured once and during the day);
• an increase in the size of the ovaries during hyperstimulation can be detected by palpation of the lower abdomen (ultrasound allows you to determine their exact dimensions, detect fluid accumulation in the abdominal cavity, and detect pregnancy, including ectopic pregnancy);
• an electrocardiogram is taken to establish the nature of disturbances in the work of the heart.

With the help of a chest x-ray, fluid accumulation in the pleural cavities, as well as in the pericardial sac, can be detected.

Treatment

The consequences of ovarian hyperstimulation are eliminated both with the help of medications and through surgical operations.

Medical treatment usually done at home or in a hospital, with the woman instructed to stay in bed to minimize the risk of damage to the appendages.

In order to replenish the volume of blood that is lost due to ascites, protein, albumin, and plasma are injected intravenously. Protein compounds are necessary to maintain the functioning of the liver, restore ovarian tissues, and strengthen blood vessels.

Antiemetics, painkillers are prescribed. In severe hyperstimulation, antibiotics are used.

To alleviate the patient's condition, the fluid accumulated in the abdomen is removed by puncturing the peritoneum and installing a drainage tube. Fluid is also drained from the chest cavity through a puncture in the chest wall.

If necessary, when renal failure occurs, hemodialysis is carried out using the “artificial kidney” apparatus.

Surgical treatment is carried out in acute situations, when there is damage to the ovaries, there are signs of anemia resulting from severe internal bleeding. The operation is usually performed through an incision in the abdominal wall.

Prevention

To avoid ovarian hyperstimulation, first of all, it is necessary to take into account all contraindications, to assess the risk of the stimulation procedure. It is necessary to carefully follow the prescriptions of the doctor, to prevent an overdose of drugs.

The procedure is carried out only when the woman is in good physical shape, not nervous, eats well, eats enough protein foods.

Agreeing to in vitro fertilization, a woman rarely thinks about the possible complications of the procedure.

However, according to statistics, adverse effects are quite often detected in patients. One of them and the most serious is ovarian hyperstimulation syndrome (OHSS) in IVF.

What is ovarian hyperstimulation syndrome

OHSS is called an ovarian reaction in response to a high dosage of hormone therapy drugs (Gonal) prescribed during reproductive technology. Drugs stimulate an increase in the number of oocytes that mature within 1 cycle. As a result, the patient produces an increased amount of estradiol, which leads to an increase in blood clotting and capillary permeability. The accumulated fluid in the tissues causes swelling.

Doctors believe that ovarian hyperstimulation syndrome is the most severe complication of in vitro fertilization. The probability of a woman encountering him is quite high, especially when conducting a long protocol and hereditary predisposition.

OHSS can occur in a patient both before implantation of the embryo into the uterine wall, and at the onset of the gestational period. If the symptoms began early and intensely, the course of the disease is more severe compared to the late and gradual onset.

Who is at risk of OHSS with IVF

After performing in vitro fertilization, it is impossible to predict whether a patient will develop a pathology or not. However, there is a category of individuals who have a certain predisposition to hyperstimulation syndrome.

These include:

1. Women with light hair color (a feature of the genotype).
2. Under 35 years of age.
3. Having a small weight.
4. Prone to allergic reactions.
5. Patients with polycystic ovaries.
6. Patients with high plasma estradiol activity.
7. Ladies who are assigned a protocol with the help of GnRH.
8. Women who are undergoing luteal phase support with increased or repeated doses of hCG preparations.
9. Patients with double stimulation.

Given the presence of risk factors, the attending physician is able to predict and timely identify the pathological process in the patient.

Forms of the disease

Experts distinguish 2 forms of OHSS:

1. Early ovarian hyperstimulation syndrome. This type of pathology develops immediately after the maturation of the eggs. When the embryo has attached to the uterine wall, immediate treatment of the disease is required to avoid its transformation into a late form. If the patient's pregnancy did not take place, the disease disappears on its own after the next menstruation.
2. Late OHSS. It is detected at 5-12 weeks of the gestational period. It is characterized by a severe course and requires timely therapy.

Symptoms

Given the severity of the signs of hyperstimulation syndrome, doctors distinguish several degrees of pathology.

Let us consider in detail the main manifestations of each of them.

mild severity

The general condition does not cause concern. At first, the disease manifests itself in the form of pulling pains in the lower abdomen, a feeling of fullness in it. Women note that the waist circumference becomes 2-3 cm larger and the weight increases slightly.

Soreness appears, as during menstruation, and urination becomes more frequent. Such changes are explained by an increase in the size of the ovaries due to the appearance of formations in them (follicular, luteal cysts), circulatory disorders with accumulation of fluid in the chest cavity and abdomen (ascites).

Average degree

The woman's health is deteriorating. The pains intensify, become intense due to the continued growth of the ovaries in size and the accumulation of fluid in the abdominal cavity, which causes irritation of the peritoneum.

The patient complains of the appearance of digestive disorders - nausea with vomiting, stool disorders. The abdomen increases in circumference, and during ultrasound diagnostics, ascitic fluid is visualized in the abdominal cavity. Progressive weight gain. The frequency of respiratory movements and contractions of the heart increases.

Severe degree

The general condition of the woman is grave. There is a feeling of fear, there are headaches and dizziness. Organ dysfunction develops - heart and respiratory failure, which forces the patient to sit or take a prone position with the head end of the bed highly raised. There is shortness of breath, tachycardia, body temperature rises, as with a cold, and blood pressure decreases.

On palpation, the abdomen is enlarged in circumference due to ascites. The face, lower extremities and external genitalia swell, extremely rarely anasarca develops (edema of the subcutaneous tissue).

critical degree

The condition of the woman is regarded as extremely serious. Subjective complaints remain the same as in severe hyperstimulation syndrome. There is a significant decrease in the volume of excreted urine: no more than 1000 ml.

During the examination of the doctor, the patient revealed shortness of breath, tachycardia. For this degree, it is characteristic that the symptom of peritoneal irritation is positive, and palpation determines an increase in the liver and pronounced ascites with accumulation of fluid in the abdominal cavity up to 5-6 liters. The ovaries are greatly enlarged and are easily determined by probing the lower abdomen. Manifestations of cardiac and respiratory failure are pronounced.

How is OHSS diagnosed?

To make a correct diagnosis with the subsequent appointment of therapy, the doctor conducts a complete examination of the woman.

Diagnostics includes:

1. Conducting a gynecological and general examination of the patient.
2. Ultrasound of the pelvic organs and the abdominal cavity - the size of the ovaries is determined, how much ascitic fluid has accumulated.
3. Clinical and biochemical research of blood, analysis of hormones in plasma.
4. Echocardiography of the heart and ECG: if heart failure occurs, signs of pathology are determined.
5. X-ray of OGK: to determine the fluid in the cavities of the pleura and pericardium.

Depending on the course and clinical manifestations of OHSS, the list of diagnostic procedures is supplemented. With the development of a severe and critical degree, an examination by a cardiologist, pulmonologist and gastroenterologist is required.

Blood and urine tests

With a mild form of the syndrome, blood and urine values ​​are normal. The average degree of OHSS is characterized by a hematocrit content of no more than 45%.

A severe degree is accompanied by a reduced daily diuresis, an increase in hematocrit over 45%. There is a leukocytosis exceeding 15×10⁹/L. In the biochemical analysis, an increase in the content of ALT, AST, a decrease in the level of total protein is visualized. In OAM, the density of urine increases and proteinuria is observed.

The critical degree of OHSS is characterized by an increase in hematocrit over 55%, leukocytosis (over 25x10⁹/l). In a biochemical analysis, an imbalance of electrolytes and blood coagulation is determined with the development of its thickening. The test for sex hormones fixes their high level in plasma. Urinalysis reveals a protein in the biological fluid, a decrease in its excretion (oliguria) and an increase in specific gravity.

Methods of treatment

The initial effects of OHSS do not require special treatment of the patient in a hospital setting. Usually it is possible to get rid of the disease in 2-3 weeks.

Treatment for mild hyperstimulation syndrome includes:

1. Compliance with the drinking regimen: a woman needs to drink a significant amount of liquid, excluding alcohol and carbonated drinks. It is advisable to consume mineralized water to avoid electrolyte imbalance.
2. Stick to a balanced diet with the inclusion of products containing an increased amount of protein. It is necessary to refrain from eating foods rich in fiber.
3. Exclusion of sexual contact and any physical activity.
4. Urine output tracking and changes in body weight.

Therapy of moderate and severe OHSS is carried out in a hospital, as the deterioration of the patient's condition can occur very quickly. The hospital should be specialized and equipped with an intensive care unit or ward.

To combat hyperstimulation syndrome, doctors carry out the following treatment regimen:

1. Drugs that replenish blood volume and improve its properties. The doctor prescribes droppers with crystalloid solutions (Ringer's solution, Trisol, Ionosteril), and then colloidal plasma-substituting solutions (Infucol, Volukam, Refortan).
2. Anticoagulants - Fraxiparine, Clexane. They are necessary to prevent thrombosis.
3. Antibiotics (Cephalosporins, Fluoroquinolones) as a prevention of the addition of bacterial microflora.
4. Antispasmodics (No-shpa, Papaverine) and NSAIDs to reduce abdominal pain.

Plasmapheresis is necessary to improve the composition of the blood. If pronounced intense ascites is observed in OHSS, unnecessary fluid is evacuated from the abdominal cavity. For this, an abdominal or transvaginal puncture is performed.

If a woman is pregnant, but she develops a critical degree of hyperstimulation syndrome, an artificial termination of pregnancy is necessary.

Possible consequences

Complications of the disease depend on the timeliness of detection and treatment. The higher the degree of OHSS, the greater the likelihood of adverse effects.

In severe forms of ovarian hyperstimulation syndrome, various diseases often join:

• ascites;
• heart and respiratory failure;
• acute renal failure due to a decrease in the volume of circulating blood and its increased clotting;
• torsion and rupture of the ovary with the formation of massive blood loss;
• ectopic pregnancy: attachment of the embryo outside the uterine cavity;
• exhausted ovary syndrome (it is considered the most formidable complication of OHSS, in which there is an early cessation of the functioning of these organs before menopause - the cells stop maturing, menstruation disappears. When the syndrome affects both ovaries, the woman becomes infertile).

If a woman is caught with OHSS during pregnancy, it often proceeds with adverse consequences. So, in the early stages, the threat of miscarriage increases, and at the end of gestation - premature birth. During the entire pregnancy, there is a high probability of the occurrence of placental insufficiency, hypoxia of the child in the womb and delayed development of the baby inside the womb.

How to avoid illness - preventive measures

To prevent ovarian hyperstimulation syndrome, the doctor determines the existing risk factors for each patient.

In addition, the specialist takes the following measures:

1. Starting hormone therapy begins with a reduced dose.
2. Do not use ovulatory dose of hCG.
3. She uses Doxinex on the day she takes her ovulation inducing medication (Menopur).
4. Stimulation should last for a short time. For this, a late intake of hormones or an early administration of hCG is used.
5. Carries out a puncture of available follicles.
6. Uses progesterone instead of hCG to maintain luteal phase.
7. Constantly controls the content of estrogens in the in vitro fertilization cycle.
8. Conducts dynamic monitoring of the well-being and general condition of the woman.