How long does ovarian hyperstimulation syndrome last? How dangerous is ovarian hyperstimulation syndrome and its treatment methods

One of the most frequent and most formidable complications that occur during artificial insemination is ovarian hyperstimulation during IVF. Its main reason is the excess of doses of drugs that are administered to stimulate ovulation. In the vast majority of cases, this condition is successfully treated - but only on condition that the necessary measures were taken in time.

Under natural conditions in the female body, one egg cell matures 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 with the wrong choice of drugs and their dosage. However, there are several factors that contribute to its development:

polycystic ovaries;
tendency to allergic reactions;
increased activity of estradiol;
the use of hCG preparations 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. Very rarely they are found even on the background of 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. On ultrasound, it can be seen that the ovaries increase in size up to 6 centimeters.
Medium degree: bloating, increased swelling, weight gain, vomiting and nausea. The size of the ovaries is 8-12 cm.
Severe degree: a noticeable increase in the volume of the abdomen, vomiting, hypotension, shortness of breath, interruptions in the work of the heart. In addition, signs of ascites are noted, the functioning of the liver is disturbed, and accumulation of fluid in the pleural cavity is recorded. The ovaries are enlarged more than 12 cm.

Some of the symptoms the patient describes in her reviews:

Anya: “About a week after the transfer, I began to have severe itching, which lasted 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 canceled, everything returned to normal, there is no water anywhere, however, I lost a little weight.

Natasha: “I had a very severe hyper. A lot of fluid has accumulated - 10 liters in the stomach and 1.5 liters in each lung. For a month I hardly ate, could not sleep, screamed from pain. For almost a month I lay under a dropper, the pregnancy eventually froze at the eighth week. The fluid went away completely only after four months.

Ira:“It all started on the sixth day after the transfer. At first it was tolerable, kept a diet and drank. Then it twisted so that they called an ambulance, they performed an operation in the hospital. It turned out that a huge cyst had formed, due to which the ovary was twisted. ”

How to treat?

The basis of the treatment of mild hyperstimulation is a protein diet and plenty of fluids.

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

drinking plenty of water, except for alcohol and carbonated drinks;
the use of protein foods;
in priority - lean white meat, lean veal, boiled fish;
balanced nutrition with the inclusion of cereals, greens, 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. As a rule, 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 fluid from the abdominal cavity and surgical intervention may be indicated - for example, if cyst ruptures and internal bleeding occur. In the reviews, the patients talk about the methods of treatment prescribed to them:

Maria:“You need to drink plenty of water and eat protein foods. Nothing salty and no diuretics! You still can’t eat foods that can cause bloating - grapes, black bread, legumes, cabbage. Fish and meat are allowed without restrictions.

Katia:“I started after the puncture - by the evening my stomach ached, it was difficult to breathe, I could not be in an upright position. The next day he was admitted to the hospital, they put refortan droppers. But in the end, the embryos were sent to cryo, and replanting was done only after two cycles.”

Julia: “My hypera started early, two days after the puncture. I was immediately dripped, then for another two days I lay for six hours under droppers. From problems with the intestines, which almost everyone has, I drank Dufalac and Hilak forte.

Eve: “I was covered the next day after the puncture, everything lasted about a week. The abdomen was huge, they wanted to puncture, but everything worked out with droppers - they put refortan and albumin. From the droppers, it only felt worse, it seemed that the stomach was about to burst. But in fact, they are necessary, because it is physically impossible to eat so much protein.

Possible consequences

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

ascites;
respiratory failure due to the appearance of fluid in the chest cavity;
kidney failure;
ovarian rupture;
torsion of the ovary with subsequent necrosis;
premature ovarian failure.

How to avoid hyperstimulation?

The main measure for the prevention of ovarian hyperstimulation in IVF is an individual approach on the part of the doctor, for the correct selection of drugs and their dosage. If symptoms have already begun to appear, the following measures can help prevent OHSS:

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

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

Yana: "From the seventh day of stimulation, I drank Dostinex as prescribed to prevent hyperstimulation."

Katia: “I had every chance of getting OHSS, because the male factor became the cause of infertility, and my body worked well even without stimulation. Besides, I'm 30 years old, I'm small and fair-haired. To avoid all this, I drank Dostinex. I know that someone does not tolerate it very well, there are nausea and dizziness. But I didn't see anything like that."

Vika: “The doctor advised me to take protein in 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?

Planning to re-attempt IVF is not recommended for 2-3 months after hyperstimulation. This time is necessary to restore the hormonal background and normalize ovarian function. In difficult cases, if complications could not 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 syndrome (OHSS)- This is a pathological condition that develops after the use of hormonal agents in order 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, 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.

Instrumental diagnostics in ovarian hyperstimulation syndrome is implemented by X-ray of the chest, 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 teeth, 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 evaluate the dynamics of the heart.

Treatment of ovarian hyperstimulation syndrome

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

With RDS, oxygen support or mechanical ventilation is mandatory. With severe hemodynamic disturbances or a critical condition of the patient, antibiotic therapy is carried out in order to prevent bacterial complications. Surgical treatment for ovarian hyperstimulation syndrome may include the evacuation of accumulated fluid (laparo- and thoracocentesis, pericardial puncture), median laparotomy for internal bleeding, torsion or rupture of the ovary, etc.

Prediction 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 I and II trimesters, placental insufficiency and premature birth in the III trimester. Prevention of ovarian hyperstimulation syndrome includes detailed compliance with the instructions of the attending obstetrician-gynecologist, the use of lower doses of drugs in the presence of risk factors for OHSS, a balanced diet with the use of a large volume of fluid, the prevention of physical or psycho-emotional overload, a full examination before the start of ovulation stimulation, abstinence from sexual activity .

Ovarian hyperstimulation: symptoms, consequences of OHSS after puncture and pregnancy

Ovarian hyperstimulation syndrome (OHSS) is one of the most formidable and unpleasant consequences of ovarian stimulation in the cycle. The existence of OHSS needs to be known to those who are only and those who have already had unsuccessful attempts, but repeated protocols are ahead. Any intervention in the body does not remain without consequences. But when the birth of a child is on the scales and, anyway, in most cases, the instinct to become a mother wins.

What is ovarian hyperstimulation?
Early and late OHSS
Signs of hyperstimulation after puncture
Effects
How to avoid OHSS
Who is at risk
Symptoms of hyperstimulation
What should be alarming
Treatment

What is ovarian hyperstimulation

Ovarian hyperstimulation is a serious complication of ovarian stimulation, which is based on an uncontrolled response of the ovaries to the administration of gonadotropins (drugs that are administered to induce ovulation).

Without the presence of hCG, hyperstimulation will not develop. The hormone is a trigger in the appearance of symptoms and manifestations. Therefore, it is very important to monitor how the follicles grow, how many there are, and carefully choose the drug - - before. Drugs that are prescribed before the follicle puncture are prescribed for the "ripening" of the eggs. They contain human chorionic gonadotropin (hCG).

Ovarian hyperstimulation in IVF and pregnancy

If symptoms of hyperstimulation appear at the “after puncture” stage, it is recommended to postpone the transfer, and transfer it in a natural cycle or in). In the current situation, this is a good solution. A woman will endure mild hyperstimulation, the body will recover and the effectiveness of IVF protocols with cryopreservation is much higher - 65-70%, versus 30-35%.

Signs of hyperstimulation after ovarian puncture:

temperature increase up to 38 °C;
bloating;
the appearance of edema, including ascites - the accumulation of fluid in the abdominal cavity;
difficulty urinating;
nausea and vomiting.

Consequences of hyperstimulation

The consequences of an excessive ovarian response to stimulation include:

Ascites is the accumulation of fluid in the peritoneal space, hydrothorax is the accumulation of fluid in the pleural cavities. This complication occurs as a result of the launch of processes atypical for the physiological state, as a result of which blood plasma sweats through the mucous membranes and accumulates in the cavities.
Torsion (complete and partial) of the ovaries is a rare consequence, but if it occurs, it requires surgical treatment.
Gap.
Follicular cysts.
Renal failure.
Liver failure.

How to avoid hyperstimulation during IVF

It is almost impossible to completely avoid OHSS during IVF. During in vitro fertilization, the actions of doctors and supervision are aimed at preventing the development of serious conditions. It is very important to notice the development of an uncontrolled reaction of the body in time and take measures to prevent severe forms of OHSS.

Identification of risk factors. For this, the hormonal background is controlled, much attention is paid to the hormone. Ultrasound and folliculometry are performed already during stimulation.
Very mild stimulation schemes with low doses of drugs are used ().

The body of young girls with a good ovarian reserve, a normal level of AMH - can respond to a mild induction of ovulation by the growth of a large number of follicles. Hyperstimulation can also be prevented at this stage.

Prevention at the stage of ovarian stimulation:

the choice of drugs for the maturation of eggs that do not contain hCG;
delayed ovulation trigger:
cancel ;
use, if necessary, special preparations Dostinex or Cabergoline, low molecular weight heparins - Fraxiparin, Clexane.

Who is at risk for developing OHSS

Risk factors for the development of hyperstimulation are:

young age;
low body mass index (small, thin, slender girls);
or multifollicular ovaries;
high concentration of anti-Müllerian hormone (if the concentration is higher than 3.7 ng / ml, the higher the risk of developing an excessive ovarian response if stimulation is not carried out correctly);
a large number of antral follicles, determined by ultrasound (more than 10 follicles from 4 to 10 in each ovary;
history of hyperstimulation (in previous IVF attempts);
aggravated allergic history.

Symptoms of ovarian hyperstimulation and classification

Mild manifestations of hyperstimulation occur in many patients of reproductive clinics.

Signs of ovarian hyperstimulation to watch out for

Be sure to tell your doctor if there are such signs of hyperstimulation:
weakness, dizziness, decreased blood pressure;
shortness of breath, respiratory disorders;
distension in the abdomen, bloating, pain in the hypochondrium and in the abdomen (diffuse);
rare and scanty urination;
increase in body temperature;
swelling of the external genital organs and lower extremities.

What is hyperstimulation syndrome based on?

Attention! When examining for the presence of ovarian hyperstimulation syndrome, a gynecological examination is prohibited.

blood pressure, respiratory rate, daily diuresis, abdominal circumference are measured
Laboratory studies are carried out: a complete blood count with hematocrit (total protein, albumin, hepatic transaminases), hemostasiogram (D-dimer).
Ultrasound of the small pelvis, abdominal cavity, pleural cavities.

Treatment of ovarian hyperstimulation

There is no pathogenetic treatment of ovarian hyperstimulation syndrome; all therapeutic measures are aimed at eliminating the symptoms of dysfunction of internal organs. Ovarian hyperstimulation is treated until the stabilization of clinical and laboratory parameters and the elimination of symptoms. Mild to moderate OHSS is treated on an outpatient basis, with severe OHSS requiring hospitalization.

For moderate hyperstimulation, the following simple corrective measures are necessary:

Normalization of water metabolism - you need to drink up to 2 liters of fluid;
A protein diet is prescribed. The goal is to limit foods that cause fermentation in the intestines and bloating. Vegetables, fruits, carbohydrates in large quantities are limited. Preference is given to protein foods: boiled chicken, fish, cottage cheese.
To monitor the development of OHSS, body weight, abdominal circumference, and daily urine output are measured.

According to the indications, low molecular weight heparins are prescribed, under the control of D-dimer, and infusion therapy under the control of diuresis.

In severe hyperstimulation, antispasmodics may be prescribed. With severe and progressive ascites, laparocentesis is performed - a manipulation in which a puncture of the abdominal cavity is made and the accumulated fluid is removed. Surgical surgical treatment is carried out only in urgent cases in the presence of acute gynecological complications.

To avoid severe manifestations of ovarian hyperstimulation and the consequences, you must strictly follow your doctor's instructions and monitor your condition. In case of a sharp deterioration in well-being, it is necessary to contact the attending physician or the doctor on duty at the clinic where ovarian stimulation was performed.

Actual video

Symptoms and consequences of ovarian hyperstimulation

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, 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, sometimes mild pain. The ovaries become larger, fluid accumulates in the abdomen, blood circulation is disturbed. Some women pay attention to an increase in waist circumference, slight weight gain, slight swelling.

The transition of OHSS to a more severe stage is accompanied by increased pain in the lower abdomen, an increase in edema and abdominal volume. The accumulation of fluid occurs not only in the abdominal cavity, but also in the pleural, pericardial. Shortness of breath, hypotension, tachycardia develops. Most of the time, a woman is in bed in a half-sitting position. There is nausea, vomiting, loose stools, gases accumulate.

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

Diagnostics

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

It includes:

study of complaints and anamnesis of the patient;
general and gynecological examination, including abdominal palpation;
Ultrasound of the pelvic organs and abdominal cavity;
blood test (general, biochemical, hormones);
Analysis of urine;
ECG and ultrasound of the heart;
chest x-ray.

The list of examinations can be reduced or increased, depending on the clinical picture of the syndrome. Sometimes a consultation of narrow specialists is prescribed: a pulmonologist, a cardiologist, a 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 full and balanced diet, refrain from sexual intercourse and physical activity for several weeks. To monitor whether the syndrome is developing, you need to evaluate the amount of urine separated and weight changes daily.

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

In severe ovarian hyperstimulation syndrome, a puncture of ascitic fluid is performed , surgery (if there is or internal bleeding).

Complications

Complications of ovarian hyperstimulation syndrome include:

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

Effects

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, the 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 before 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.

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

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

When pregnancy occurs, the risk of exacerbation of 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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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:

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

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.
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:

Conducting a gynecological and general examination of the patient.
Ultrasound of the pelvic organs and the abdominal cavity - the size of the ovaries is determined, how much ascitic fluid has accumulated.
Clinical and biochemical research of blood, analysis of hormones in plasma.
Echocardiography of the heart and ECG: if heart failure occurs, signs of pathology are determined.
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:

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.
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.
Exclusion of sexual contact and any physical activity.
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:

Drugs that replenish blood volume and improve its properties. The doctor prescribes droppers with crystalloid solutions (Ringer's solution, Trisol, Ionosteril), and then colloid plasma-substituting solutions (Infucol, Volukam, Refortan).
Anticoagulants - Fraxiparine, Clexane. They are necessary to prevent thrombosis.
Antibiotics (Cephalosporins, Fluoroquinolones) as a prevention of the addition of bacterial microflora.
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. Throughout 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:

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