What is ovarian hyperstimulation syndrome?
Ovarian hyperstimulation syndrome affects women taking injectable hormone medications to stimulate the development of eggs in the ovaries. This may occur in women undergoing in vitro fertilization (IVF), ovulation induction or intrauterine insemination.
Too much hormone medication in your system can lead to ovarian hyperstimulation syndrome (OHSS), in which your ovaries become swollen and painful. A small number of women may develop severe OHSS, which can cause rapid weight gain, abdominal pain, vomiting and shortness of breath.
Less often, OHSS happens during fertility treatments using medications you take by mouth, such as clomiphene (Clomid, Serophene). Occasionally OHSS occurs spontaneously, not related to fertility treatments.
How common is ovarian hyperstimulation syndrome?
Mild OHSS is common in women having IVF treatment; affecting as many as 33 in 100 women (33%). However, just over 1 in 100 women (1%) will develop moderate or severe OHSS. Most of your symptoms should resolve in 7–10 days. Please discuss with your doctor for further information.
What are the symptoms of ovarian hyperstimulation syndrome?
The common symptoms of ovarian hyperstimulation syndrome are:
- Abdominal bloating
- Mild pain in the abdomen
- Weight gain
In rare cases, women can have more serious symptoms, including:
- Rapid weight gain (more than 10 pounds or 4.5 kilograms in 3 to 5 days)
- Severe pain or swelling in the belly area
- Decreased urination
- Shortness of breath
- Nausea, vomiting, or diarrhea
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes ovarian hyperstimulation syndrome?
The cause of ovarian hyperstimulation syndrome isn’t fully understood, although 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.
What increases my risk for ovarian hyperstimulation syndrome?
There are many risk factors for ovarian hyperstimulation syndrome, such as:
- 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 30
- Low body weight
- High or steeply increasing level of estradiol (estrogen) before an HCG trigger shot
- Previous episodes of OHSS
In some cases, OHSS affects women who have no risk factors at all.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is ovarian hyperstimulation syndrome diagnosed?
If you have a severe case of OHSS, your health care provider will need to monitor your symptoms carefully. You may be admitted to the hospital.
Your weight and the size of your belly area (abdomen) will be measured. Tests that may be done include:
- Abdominal ultrasound or vaginal ultrasound
- Chest x-ray
- Complete blood count
- Electrolytes panel
- Liver function test
- Tests to measure urine output
How is ovarian hyperstimulation syndrome treated?
Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications.
Mild to moderate OHSS
Mild OHSS typically resolves on its own. Treatment for moderate OHSS may involve:
- Anti-nausea medication, prescription painkillers or both
- Frequent physical exams and ultrasounds
- Daily weigh-ins and waist measurements to check for drastic changes
- Measurements of how much urine you produce each day
- Blood tests to monitor for dehydration, electrolyte imbalance and other problems
- Adequate fluid intake
- Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity
- Support stockings, to help prevent blood clots
With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your doctor may give you a medication called cabergoline to lessen your symptoms. In some cases, your doctor may also give you another medication — known as a gonadotropin-releasing hormone (Gn-RH) antagonist — to help suppress ovarian activity.
Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage ovarian hyperstimulation syndrome?
The following lifestyles and home remedies might help you cope with ovarian hyperstimulation syndrome:
- Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as these drugs can interfere with implantation of the newly fertilized egg.
- Avoid sexual intercourse, as it may be painful and can cause a cyst in your ovary to rupture.
- Maintain a light physical activity level, avoiding strenuous or high-impact activities.
- Weigh yourself on the same scale and measure around your abdomen each day, reporting unusual increases to your doctor.
- Call your doctor if your signs and symptoms get worse.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: November 23, 2017 | Last Modified: December 8, 2019
Ovarian hyperstimulation syndrome. https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697. Accessed November 24, 2017.
Ovarian hyperstimulation syndrome. https://medlineplus.gov/ency/article/007294.htm. Accessed November 24, 2017.
Ovarian hyperstimulation syndrome - RCOG. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi_ohss.pdf. Accessed November 24, 2017.