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Ovarian Hyperstimulation Syndrome(OHSS)

The drugs used in super ovulation (production of multiple follicle and eggs in one cycle) are not without side effects.

Great care is taken to monitor the cycle and the drug regimen is tailored to each individual case. But the ovarian response in the same woman, from the same drug, in the same dosage is variable in different cycles. The ovarian response is hence unpredictable. The need for careful monitoring of the cycles with hormone tests and ultrasound scans cannot be overstressed.

In about 8-10% of cases the ovaries respond unpredictably excessively with the growth of large number of follicles to gonadotrophin stimulation. In certain condition like polycystic ovaries the incidence could be as high as 60-80% in spite of careful monitoring. This results in Ovarian Hyper Stimulation Syndrome (OHSS) with enlarged painful ovaries, fluid in the abdomen (ascitis), fluid in the chest (hydrothorax), nausea, vomiting, severe electrolyte imbalance in the blood and reduced urine output resulting in kidney failure.

If it is not diagnosed immediately and actively treated this could result in death. You are advised to drink about 3 litres of water per day and take a high protein diet. If there is a possibility of OHSS then you are warned to report to the doctor daily by telephone regarding pain, abdominal swelling, vomiting and urine output. You will be asked to come to the centre for check up as necessary. You should follow these instructions without fail. Admission to the centre for several days may be necessary in some cases. Unfortunately this will result in additional expenditure, which may be unavoidable under the circumstances and has to be borne by the patient.

The incidence of polycystic ovaries (PCO) in the western world is around 12%. But in India the incidence is around 20%. In Saudi Arabia it is around 60%. The higher incidence is most likely due to genetic factor. The diagnosis of PCO is made by clinical history, clinical appearance of the patient, hormone tests and / or ultrasound scan of the ovaries. Sometimes all the factors may be negative but on ovarian stimulation, the ovaries respond typically in polycystic manner. In some cases of PCO even if the fallopian tubes are normal and patent it may be necessary to resort to IVF treatment as there may be excessive follicular development hence any other treatment may lead to multiple pregnancy.

The doctor will discuss these factors with you at the time of consultation. In some cases the treatment cycle may have to be cancelled because of the risk of OHSS. In some cases IVF treatment may be necessary to collect all the eggs, fertilize and freeze them when there is risk of OHSS. No embryos will be replaced as a pregnancy may exaggerate the risk of OHSS. Special treatment to suppress the ovaries and reduce the risk of hyper stimulation is continued. The most important of these is to consume a high protein diet, and drink as much as 4 litres of water apart from the other fluids like coffee and tea.

The most effective treatment to minimize the risk of OHSS is called IVM. Here the eggs are collected after 5-8 days stimulation while the ovarian follicles are only 2-5mm in diameter and these immature eggs are cultured in the laboratory to reach maturity. They are then subjected to ICSI and fertilized. The resulting embryos are transferred on day 3, 4 or 5. By this method the risk of OHSS is completely eliminated. This treatment is available at Miracle but NOT in other centres in India.