Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome
 Symptoms & causes

 Diagnosis & treatment
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Overview
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Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It
usually occurs in women taking injectable hormone medications to stimulate the
development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes
the ovaries to swell and become painful.
OHSS may occur in women undergoing in vitro fertilization (IVF) or ovulation induction
with injectable medications. Less often, OHSS happens during fertility treatments using
medications you take by mouth, such as clomiphene.
Treatment depends on the severity of the condition. OHSS may improve on its own in
mild cases, while severe cases may require hospitalization and additional treatment.
Products & Services
 Book: Mayo Clinic Guide to Fertility and Conception
Symptoms
Symptoms of ovarian hyperstimulation syndrome often begin within a week after using
injectable medications to stimulate ovulation, though sometimes it can take two weeks or
longer for symptoms to appear. Symptoms can range from mild to severe and may
worsen or improve over time.
Mild to moderate OHSS
With mild to moderate ovarian hyperstimulation syndrome, symptoms can include:
 Mild to moderate abdominal pain
 Abdominal bloating or increased waist size
 Nausea
 Vomiting
 Diarrhea
 Tenderness in the area of your ovaries

Some women who use injectable fertility drugs get a mild form of OHSS. This usually
goes away after about a week. But, if pregnancy occurs, symptoms of OHSS may
worsen and last several days to weeks.
Severe OHSS
With severe ovarian hyperstimulation syndrome, you might have:
 Rapid weight gain — more than 2.2 pounds (1 kilogram) in 24 hours
 Severe abdominal pain
 Severe, persistent nausea and vomiting
 Blood clots
 Decreased urination
 Shortness of breath
 Tight or enlarged abdomen
When to see a doctor
If you're having fertility treatments and you experience symptoms of ovarian

hyperstimulation syndrome, tell your doctor. Even if you have a mild case of OHSS, your
doctor will want to observe you for sudden weight gain or worsening symptoms.
Contact your doctor right away if you develop breathing problems or pain in your legs
during your fertility treatment. This may indicate an urgent situation that needs prompt
medical attention.
Request an Appointment at Mayo Clinic
Causes
The cause of ovarian hyperstimulation syndrome isn't fully understood. Having a high
level of human chorionic gonadotropin (HCG) — a hormone usually produced during
pregnancy — introduced into your system plays a role. Ovarian blood vessels react
abnormally to HCG and begin to leak fluid. This fluid swells the ovaries, and sometimes
large amounts move into the abdomen.
During fertility treatments, HCG may be given as a "trigger" so that a mature follicle will
release its egg. OHSS usually happens within a week after you receive
an HCG injection. If you become pregnant during a treatment cycle, OHSS may worsen
as your body begins producing its own HCG in response to the pregnancy.
Injectable fertility medications are more likely to cause OHSS than is treatment with
clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs
spontaneously, not related to fertility treatments.
Risk factors
Sometimes, OHSS happens in women with no risk factors at all. But factors that are
known to increase your risk of OHSS include:
 Polycystic ovary syndrome — a common reproductive disorder that causes

irregular menstrual periods, excess hair growth and unusual appearance of the
ovaries on ultrasound examination
 Large number of follicles
 Age under 35
 Low body weight
 High or steeply increasing level of estradiol (estrogen) before an HCG trigger shot
 Previous episodes of OHSS
Complications
Severe ovarian hyperstimulation syndrome is uncommon, but can be life-threatening.

Complications may include:
 Fluid collection in the abdomen and sometimes the chest
 Electrolyte disturbances (sodium, potassium, others)
 Blood clots in large vessels, usually in the legs
 Kidney failure
 Twisting of an ovary (ovarian torsion)
 Rupture of a cyst in an ovary, which can lead to serious bleeding
 Breathing problems
 Pregnancy loss from miscarriage or termination because of complications
 Rarely, death
Prevention
To decrease your chances of developing ovarian hyperstimulation syndrome, you'll need

an individualized plan for your fertility medications. Expect your doctor to carefully
monitor each treatment cycle, including frequent ultrasounds to check the development
of follicles and blood tests to check your hormone levels.
Strategies to help prevent OHSS include:
 Adjusting medication. Your doctor uses the lowest possible dose of

gonadotropins to stimulate your ovaries and trigger ovulation.
 Adding medication. Some medications seem to reduce the risk of OHSS without
affecting the odds of pregnancy. These include low-dose aspirin; dopamine
agonists such as carbergoline or quinogloide; and calcium infusions. Giving women
who have polycystic ovary syndrome the drug metformin (Glumetza) during ovarian
stimulation may help prevent hyperstimulation.
 Coasting. If your estrogen level is high or you have a large number of developed
follicles, your doctor may have you stop injectable medications and wait a few days
before giving HCG, which triggers ovulation. This is known as coasting.
 Avoiding use of an HCG trigger shot. Because OHSS often develops after
an HCG trigger shot is given, alternatives to HCG for triggering have been
developed using Gn-RH agonists, such as leuprolide (Lupron), as a way to prevent
or limit OHSS.
 Freezing embryos. If you're undergoing IVF, all the follicles (mature and
immature) may be removed from your ovaries to reduce the chance of OHSS.
Mature follicles are fertilized and frozen, and your ovaries are allowed to rest. You
can resume the IVF process at a later date, when your body is ready.

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Ovarian hyperstimulation syndrome

 Symptoms & causes

In vitro fertilizationOpen pop-up dialog box

Products & Services

 Book: Mayo Clinic Guide to Fertility and Conception

Mild to moderate OHSS

With mild to moderate ovarian hyperstimulation syndrome, symptoms can include:

 Mild to moderate abdominal pain

 Abdominal bloating or increased waist size

 Tenderness in the area of your ovaries

With severe ovarian hyperstimulation syndrome, you might have:

 Rapid weight gain — more than 2.2 pounds (1 kilogram) in 24 hours

 Severe abdominal pain

 Severe, persistent nausea and vomiting

 Tight or enlarged abdomen

When to see a doctor

If you're having fertility treatments and you experience symptoms of ovarian

Request an Appointment at Mayo Clinic

 Polycystic ovary syndrome — a common reproductive disorder that causes

 Large number of follicles

 Low body weight

 Previous episodes of OHSS

Severe ovarian hyperstimulation syndrome is uncommon, but can be life-threatening.

 Fluid collection in the abdomen and sometimes the chest

 Electrolyte disturbances (sodium, potassium, others)

 Blood clots in large vessels, usually in the legs

 Rupture of a cyst in an ovary, which can lead to serious bleeding

 Pregnancy loss from miscarriage or termination because of complications

To decrease your chances of developing ovarian hyperstimulation syndrome, you'll need

Strategies to help prevent OHSS include:

 Adjusting medication. Your doctor uses the lowest possible dose of

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