Zespół nadmiernej stymulacji jajników
Objawy

Zespół nadmiernej stymulacji jajników (OHSS) jest powikłaniem farmakologicznym stosowanym w procedurach wspomaganego rozrodu, zwłaszcza IVF, charakteryzującym się obrzękiem jajników i przesunięciem płynów do trzeciej przestrzeni. OHSS dzieli się na wczesny (4-7 dni po hCG) i późny (≥9 dni po hCG, związany z ciążą), a jego nasilenie klasyfikuje się jako łagodne, umiarkowane, ciężkie i krytyczne. Łagodne i umiarkowane formy dotyczą 20-35% cykli IVF, objawiając się bólem brzucha, wzdęciami, nudnościami, wymiotami, biegunką, tkliwością jajników oraz przyrostem masy ciała (>2 funty dziennie). W umiarkowanym OHSS jajniki powiększają się do 5-12 cm, a w ciężkim (0,1-3% cykli) dochodzi do wodobrzusza, wysięku opłucnowego, duszności, oligourii, zakrzepicy i innych powikłań zagrażających życiu. W badaniach laboratoryjnych obserwuje się hematokryt >55%, leukocytozę >25 000/mm³, hiponatremię (Na <135 mmol/L), hiperkaliemię (K >5 mmol/L) oraz wzrost kreatyniny (1,1-1,5 mg/dl). Wielkość jajników w ciężkim OHSS może przekraczać 12 cm, a w krytycznym nawet 25 cm.

  1. Zespół nadmiernej stymulacji jajników – objawy
    1. Czas wystąpienia objawów
    2. Objawy łagodnego i umiarkowanego OHSS
    3. Objawy ciężkiego OHSS
  2. Przebieg zespołu nadmiernej stymulacji jajników
    1. Przebieg w przypadku braku ciąży
    2. Przebieg w przypadku ciąży
    3. Progresja objawów
    4. Zmiany w jajnikach
    5. Powikłania OHSS
  3. Monitorowanie i reakcja na objawy
    1. Kiedy należy skontaktować się z lekarzem
    2. Samokontrola w warunkach domowych
    3. Przebieg samoograniczający
  4. Monitorowanie laboratoryjne i diagnostyczne
    1. Badania laboratoryjne
    2. Badania obrazowe
    3. Wskazania do hospitalizacji
    4. Kolejne rozdziały

Zespół nadmiernej stymulacji jajników – objawy

Zespół nadmiernej stymulacji jajników (OHSS) to powikłanie występujące w wyniku zastosowania leków stymulujących funkcję jajników, najczęściej podczas technik wspomaganego rozrodu, szczególnie zapłodnienia pozaustrojowego (IVF). Charakteryzuje się obrzękiem jajników i bolesnością, a w cięższych przypadkach przesunięciem płynów z łożyska naczyniowego do tzw. trzeciej przestrzeni1. Objawy OHSS mogą różnić się nasileniem – od łagodnych do ciężkich, a ich przebieg i czas trwania zależą od wielu czynników23.

Czas wystąpienia objawów

Objawy zespołu nadmiernej stymulacji jajników najczęściej pojawiają się w ciągu tygodnia po zastosowaniu iniekcji leków stymulujących owulację, choć w niektórych przypadkach mogą wystąpić nawet po dwóch tygodniach od podania leków12. W literaturze medycznej wyróżnia się dwa typy OHSS w zależności od czasu wystąpienia1:

  • Wczesny OHSS – pojawia się 4-7 dni po podaniu ludzkiej gonadotropiny kosmówkowej (hCG) i zwykle ustępuje wraz z miesiączką1
  • Późny OHSS – rozpoczyna się co najmniej 9 dni po podaniu hCG w odpowiedzi na rosnący poziom hCG związany z ciążą, jest zwykle cięższy i znacząco wydłuża przebieg zespołu12

Objawy łagodnego i umiarkowanego OHSS

Łagodny i umiarkowany OHSS dotyka około 20-35% wszystkich cykli IVF i charakteryzuje się następującymi objawami123:

  • Łagodny do umiarkowanego ból brzucha
  • Wzdęcia brzucha lub zwiększenie obwodu talii
  • Nudności
  • Wymioty
  • Biegunka
  • Tkliwość w okolicy jajników
  • Niewielki przyrost masy ciała (więcej niż 2 funty dziennie)1

Przy umiarkowanym OHSS obrzęk jest bardziej nasilony z powodu gromadzenia się płynu w jamie brzusznej. Powoduje to silniejszy ból brzucha i wymioty1. W badaniu ultrasonograficznym można zaobserwować zwiększenie wymiarów jajników do 5-12 cm oraz gromadzenie się płynu w jamie brzusznej12.

Objawy ciężkiego OHSS

Ciężki OHSS występuje znacznie rzadziej, dotyka około 0,1-3% cykli leczenia, ale stanowi poważne zagrożenie dla zdrowia i życia12. Do objawów ciężkiego OHSS należą123:

  • Szybki przyrost masy ciała – więcej niż 2,2 funta (1 kg) w ciągu 24 godzin
  • Silny ból brzucha
  • Silne, uporczywe nudności i wymioty
  • Zakrzepy krwi
  • Zmniejszone oddawanie moczu
  • Ciemny mocz
  • Duszność
  • Napięty lub powiększony brzuch
  • Skrajne pragnienie i odwodnienie
  • Wodobrzusze (znaczne nagromadzenie płynu w jamie brzusznej)
  • Wysięk opłucnowy (gromadzenie się płynu w klatce piersiowej)1

W krytycznych przypadkach OHSS mogą wystąpić dodatkowo12:

  • Niewydolność nerek
  • Zaburzenia rytmu serca
  • Zakrzep powodujący niedrożność
  • Płyn wokół serca
  • Zespół ostrej niewydolności oddechowej (ARDS)
  • Sepsa

Przebieg zespołu nadmiernej stymulacji jajników

Przebieg OHSS zależy od nasilenia objawów oraz wystąpienia ciąży. Zespół ten charakteryzuje się dynamicznym rozwojem, a objawy mogą się zarówno nasilać, jak i ustępować z czasem1.

Przebieg w przypadku braku ciąży

W przypadku łagodnego do umiarkowanego OHSS, gdy nie doszło do ciąży, objawy zwykle ustępują samoistnie w ciągu 7-10 dni12. Większość przypadków OHSS poprawia się do czasu wystąpienia następnej miesiączki12. Pełne ustąpienie objawów zwykle trwa 10-14 dni od momentu ich pojawienia się1.

Przy cięższym przebiegu zespołu, czas powrotu do zdrowia może być dłuższy – kilka dni do kilku tygodni, w zależności od nasilenia objawów1.

Przebieg w przypadku ciąży

Jeśli dojdzie do ciąży, objawy OHSS mogą się nasilić i trwać znacznie dłużej – od kilku dni do nawet kilku tygodni12. Jest to spowodowane wpływem ludzkiej gonadotropiny kosmówkowej (hCG) produkowanej przez rozwijające się łożysko1.

W przypadku późnego OHSS związanego z ciążą, objawy mogą utrzymywać się przez:

  • 2-3 tygodnie po pozytywnym teście ciążowym1
  • Do 10-ego tygodnia ciąży, a następnie ustępować1
  • Nawet do końca pierwszego trymestru, gdy poziomy hCG są najwyższe1

Progresja objawów

OHSS może przebiegać dynamicznie – od łagodnego do ciężkiego w krótkim czasie1. Przebieg zespołu można podzielić na następujące etapy12:

  • Wczesne objawy: łagodny dyskomfort w jamie brzusznej, wzdęcia i nudności. Mogą wystąpić biegunka i niewielki przyrost masy ciała spowodowany zatrzymaniem płynów.
  • Objawy postępujące: dyskomfort staje się bardziej wyraźny, towarzyszą mu uporczywe nudności i wymioty. Może wystąpić szybki przyrost masy ciała i zwiększenie obwodu brzucha, a także trudności w oddychaniu, szczególnie w pozycji leżącej.
  • Ciężki OHSS: charakteryzuje się szybkim przyrostem masy ciała (15-20 kg w ciągu 5-10 dni), znacznym wodobrzuszem, ograniczonym oddawaniem moczu i dusznością1.

Zmiany w jajnikach

We wszystkich przypadkach OHSS dochodzi do powiększenia jajników, co jest markerem stopnia nasilenia zespołu1. W badaniach obrazowych można zaobserwować1:

  • Powiększenie jajników powyżej normalnych rozmiarów
  • Duże torbiele wypełnione płynem w miejscach rozwoju pęcherzyków
  • W łagodnej postaci OHSS jajniki mogą osiągać wymiary do 8 cm1
  • W umiarkowanej formie do 12 cm1
  • W ciężkiej postaci nawet do 25 cm1

Powikłania OHSS

Ciężki i krytyczny OHSS może prowadzić do poważnych powikłań, które są potencjalnie zagrażające życiu12:

  • Zakrzepica żylna – zwiększone ryzyko zakrzepów krwi w nogach lub płucach z powodu zagęszczenia krwi i zwiększonej krzepliwości12
  • Niewydolność nerek – spowodowana zmniejszonym przepływem krwi przez nerki i zmniejszonym oddawaniem moczu1
  • Pęknięcie torbieli jajnika – z nadmiernym krwawieniem1
  • Niewydolność oddechowa – wywołana wysiękiem opłucnowym i uciskiem przepony1
  • Zaburzenia elektrolitowe – hiponatremia (poziom sodu 5 mmol/L)1
  • Skręt jajnika – rzadkie, ale poważne powikłanie1

W przypadku ciąży po przebytym OHSS istnieje zwiększone ryzyko wystąpienia stanu przedrzucawkowego lub przedwczesnego porodu1. Jednak nie stwierdzono ryzyka dla rozwoju dziecka związanego z OHSS2.

Stopień OHSS Objawy kliniczne Zmiany w badaniach laboratoryjnych Zmiany w badaniach obrazowych
Łagodny – Wzdęcia brzucha
– Dyskomfort w jamie brzusznej
– Nudności
– Niewielki przyrost masy ciała 		Brak istotnych zmian Powiększenie jajników do 8 cm
Umiarkowany – Nasilenie objawów łagodnego OHSS
– Wymioty
– Ból brzucha
– Przyrost masy ciała >3 kg 		– Hematokryt >41%
– Leukocytoza >15 000/mm³
– Hipoproteinemia 		– Powiększenie jajników do 12 cm
– Obecność płynu w jamie brzusznej (wodobrzusze)
Ciężki – Znaczne wodobrzusze
– Silny ból brzucha
– Uporczywe nudności/wymioty
– Szybki przyrost masy ciała >1 kg/dobę
– Zmniejszone oddawanie moczu
– Duszność 		– Hematokryt >55%
– Leukocytoza >25 000/mm³
– Hiponatremia (Na<135 mmol/L)
– Hiperkaliemia (K>5 mmol/L)
– Kreatynina 1,1-1,5 mg/dl 		– Powiększenie jajników >12 cm
– Masywne wodobrzusze
– Wysięk opłucnowy
Krytyczny – Objawy ciężkiego OHSS
– Napięte wodobrzusze
– Znaczna duszność
– Oliguria/anuria
– Objawy zespołu ostrej niewydolności oddechowej 		– Hematokryt >60%
– Zaburzenia krzepnięcia
– Kreatynina >1,6 mg/dl
– Klirens kreatyniny <50 ml/min 		– Masywne wodobrzusze
– Znaczny wysięk opłucnowy
– Płyn w worku osierdziowym

Monitorowanie i reakcja na objawy

Ze względu na potencjalnie poważny przebieg OHSS, szczególnie istotne jest odpowiednie monitorowanie objawów i wczesna reakcja na ich wystąpienie1.

Kiedy należy skontaktować się z lekarzem

Pacjentki powinny niezwłocznie skontaktować się z lekarzem w przypadku wystąpienia następujących objawów12:

  • Utrzymujący się lub nasilający ból brzucha
  • Wymioty uniemożliwiające przyjmowanie płynów
  • Trudności z oddychaniem
  • Zmniejszone oddawanie moczu lub ciemny mocz
  • Szybki przyrost masy ciała (więcej niż 1 kg dziennie)
  • Bolesność lub obrzęk nogi (możliwy objaw zakrzepu)
  • Ból w klatce piersiowej

W przypadku ciężkiego OHSS konieczna jest natychmiastowa pomoc medyczna i hospitalizacja1.

Samokontrola w warunkach domowych

Pacjentki z łagodnym OHSS mogą być leczone w warunkach domowych, ale powinny prowadzić dokładną samokontrolę12:

  • Codzienne mierzenie masy ciała
  • Monitorowanie obwodu talii
  • Obserwacja ilości oddawanego moczu
  • Obserwacja nasilenia objawów – bólu, nudności, duszności
  • Unikanie wysiłku fizycznego
  • Odpowiednie nawodnienie

Przy umiarkowanym OHSS zalecane jest regularne monitorowanie stanu pacjentki poprzez wizyty lekarskie dwa razy w tygodniu oraz codzienne kontakty telefoniczne1.

Przebieg samoograniczający

Należy pamiętać, że OHSS jest stanem samoograniczającym się12. Nie istnieje leczenie przyczynowe, które mogłoby odwrócić OHSS, jednak objawy z czasem ustępują samoistnie1. Leczenie ma na celu łagodzenie objawów i zapobieganie powikłaniom1.

W przypadku braku ciąży objawy zwykle ustępują w ciągu 1-2 tygodni. Jeśli doszło do ciąży, objawy mogą utrzymywać się dłużej, ale ostatecznie również ustąpią bez wpływu na dalszy przebieg ciąży12.

Monitorowanie laboratoryjne i diagnostyczne

W przypadku wystąpienia OHSS konieczne jest odpowiednie monitorowanie parametrów laboratoryjnych i diagnostycznych, szczególnie przy umiarkowanym i ciężkim przebiegu zespołu1.

Badania laboratoryjne

W celu oceny stopnia nasilenia OHSS i monitorowania stanu pacjentki wykonuje się12:

  • Morfologia krwi – ocena hematokrytu (najważniejszy parametr decydujący o konieczności hospitalizacji – wartość >60% wraz z wodobrzuszem jest wskazaniem do natychmiastowej hospitalizacji)
  • Elektrolity – ocena poziomu sodu (hiponatremia) i potasu (hiperkaliemia)
  • Parametry funkcji nerek – kreatynina, mocznik, klirens kreatyniny
  • Parametry funkcji wątroby – enzymy wątrobowe
  • Parametry koagulologiczne – ocena ryzyka zakrzepicy
  • Poziom białka całkowitego i albumin – hipoproteinemia i hipoalbuminemia wskazują na przemieszczanie się płynów do trzeciej przestrzeni

Badania obrazowe

W diagnostyce i monitorowaniu OHSS kluczowe znaczenie mają12:

  • Ultrasonografia przezpochwowa lub brzuszna – ocena wielkości jajników oraz ilości płynu w jamie brzusznej
  • Badanie RTG klatki piersiowej – ocena obecności płynu w opłucnej
  • Badanie USG jamy brzusznej – ocena stopnia wodobrzusza

Wielkość jajników jest markerem stopnia nasilenia OHSS, dlatego regularne badanie ultrasonograficzne pozwala monitorować progresję lub regresję zespołu1.

Wskazania do hospitalizacji

Pacjentki z ciężkim OHSS powinny być hospitalizowane w przypadku wystąpienia12:

  • Silnego bólu brzucha
  • Nudności i wymiotów uniemożliwiających przyjmowanie płynów
  • Zagęszczenia krwi (wysokie wartości hematokrytu)
  • Znacznego wodobrzusza
  • Znacznej oligurii lub anurii
  • Spadku ciśnienia tętniczego
  • Tachypnoe lub duszności
  • Zawrotów głowy lub omdleń
  • Zaburzeń elektrolitowych
  • Nieprawidłowych wyników testów funkcji wątroby

W przypadku ciężkiego OHSS, szczególnie gdy pojawia się płyn w opłucnej, duszność, oliguria lub nieprawidłowe wyniki badań laboratoryjnych, konieczna jest hospitalizacja w celu intensywnego monitorowania i leczenia1.

Należy pamiętać, że wczesne rozpoznanie i odpowiednie leczenie OHSS ma kluczowe znaczenie dla zapobiegania poważnym powikłaniom1.

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Ovarian hyperstimulation syndrome
    https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/
    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Enlargement of the ovaries causes abdominal pain, nausea and vomiting. Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium. The incidence of moderate OHSS is estimated to be between 3 and 6%, while the severe form may occur in 0.1-3% of all cycles. OHSS has been recognized in two forms: The early form of OHSS, (within days after the ovulation triggering injection of hCG) although elicited by hCG, is related to an exaggerated ovarian response to gonadotrophin stimulation, whereas the late form (10 days after hCG) is mainly related to the secretion of placental hCG. The enlargement is sometimes as much as 25 cm. Another consequence is discomfort resulting from increased intra-abdominal pressure due to ascites. Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium. The hypovolemia of OHSS leads to hemoconcentration and creates a hypercoagulable state. Acute renal failure may result. Severe and critical forms of OHSS are potentially lethal disorders, and history taking and physical examination are paramount at the time of admission. After several days, third-space fluid begins to re-enter the intravascular space, hemoconcentration reverses and natural diuresis ensues. Complete resolution typically takes 10-14 days from the onset of initial symptoms.
  • #1 Ovarian hyperstimulation syndrome – Symptoms & causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697
    Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] 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. […] 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. […] 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.
  • #1 Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023) – practice guidance | American Society for Reproductive Medicine | ASRM
    https://www.asrm.org/practice-guidance/practice-committee-documents/prevention-and-treatment-of-moderate-and-severe-ovarian-hyperstimulation-syndrome-a-guideline/
    Ovarian hyperstimulation syndrome (OHSS) is an uncommon but serious complication associated with controlled ovarian stimulation during assisted reproductive technology (ART). Historically, moderate-to-severe OHSS has been reported to occur in approximately 1%5% of in vitro fertilization (IVF) cycles. The traditional description of the syndrome generally includes a spectrum of symptoms, including abdominal distention and discomfort, dyspnea, and findings such as ovarian enlargement, ascites, hemoconcentration, hypercoagulability, and electrolyte imbalances. […] Ovarian hyperstimulation syndrome is staged (mild, moderate, severe, or critical) by the severity of symptoms and laboratory findings. Ovarian hyperstimulation syndrome is further classified by the timing of onset (early or late). Early-onset OHSS occurs after controlled ovarian hyperstimulation and an ovulatory dose of hCG. Symptoms begin in the 47 days after the hCG trigger and usually resolve with menses. Late-onset OHSS typically begins at least 9 days after the hCG trigger in response to the rising hCG of pregnancy, is more severe, and significantly lengthens the course of OHSS. Severe OHSS can lead to life-threatening complications, including pleural effusion, acute renal insufficiency, and venous thromboembolism.
  • #1 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss
    Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] The signs and symptoms of OHSS vary depending on the severity of the condition. Symptoms often begin within a week after using medication to stimulate ovulation, though it can take two weeks for symptoms to develop. […] Symptoms of mild to moderate OHSS include: Abdominal pain. Bloating. Slight weight gain (more than 2 pounds per day). Nausea. […] In more severe cases of OHSS, symptoms may include: Excessive weight gain. Severe nausea and vomiting. Severe abdominal swelling. Difficulty breathing. Blood clots. Decreased urination. Severe abdominal pain.
  • #1 Ovarian hyperstimulation syndrome (OHSS) | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/
    OHSS can range from mild to severe: […] Mild OHSS is common and usually gets better with time. More severe cases require specialist care and hospital admission. […] It is normal to have some mild discomfort after egg collection. If you are worried or develop any of the symptoms below, you should seek medical advice. […] Mild OHSS: mild abdominal swelling, discomfort and nausea. […] Moderate OHSS: symptoms of mild OHSS, but the swelling is worse because of fluid build-up in the abdomen. This can cause abdominal pain and vomiting. […] Severe OHSS: symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour and/or you may experience difficulty breathing because of a build-up of fluid in your chest. […] Most of your symptoms should resolve in 7-10 days. If your fertility treatment does not result in a pregnancy, OHSS usually gets better by the time your next period starts. If you become pregnant, OHSS can get worse and last up to a few weeks or longer.
  • #1 Awareness of OHSS and its related treatment I FertilityDost
    https://www.fertilitydost.com/articles/article-details/ovarian-hyperstimulation-syndrome/
    Mild Ovarian Hyperstimulation Syndrome: Class 1 Uneasiness and discomfort in the abdominal area. Class 2 Both the above symptoms with vomiting, nausea, diarrhea, and ovarian enlargement of 5-12 cm. […] Moderate Ovarian Hyperstimulation Syndrome: Class 3 All the symptoms of Class 1 2 with ultrasonographic evidence of ascites (abnormal accumulation of fluid in the abdominal). […] Severe Ovarian Hyperstimulation Syndrome: Class 4 All the symptoms of Class 1, 2 3 with breathing difficulties and/or hydrothorax (fluid accumulation in the pleural cavity). […] Critical Ovarian Hyperstimulation Syndrome: Class 5 All of the above symptoms with increased blood viscosity due to hemoconcentration, diminished renal function, change in blood volume and coagulation abnormalities. […] To put it simply, Ovarian Hyperstimulation syndrome (OHSS) is a medical condition of ovarian enlargement due to several ovarian cysts.
  • #1
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/
    Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. The hallmark of OHSS is an increase in the permeability of the capillaries, resulting in a fluid shift form the intravascular space to the extravascular compartments. The main event in the pathogenesis of OHSS is ovarian enlargement, secretion of vasoactive substances, ascites, and hypovolemia resulting from an acute extravasation of fluid into the interstitial space. OHSS is classified into 4 categories based on the severity of symptoms, signs, and laboratory findings. Mild ovarian hyperstimulation syndrome is defined by the enlargement of bilateral ovaries with multiple follicular and corpus luteal cysts, measuring up to 8 cm and accompanied by abdominal bloating and mild abdominal pain. Moderate ovarian hyperstimulation syndrome is characterized by the enlargement of the ovaries up to 12 cm, accompanied by abdominal bloating due to an increase in ovarian size and gastrointestinal symptoms (e.g., nausea, vomiting, and diarrhea) as well as ultrasound evidence of ascites. Severe ovarian hyperstimulation syndrome is described by the presence of large ovarian cysts (1212 cm), clinical ascites with or without hydrothorax, hyperkalemia (potassium 5 mmol/L), hyponatremia (sodium 135 mmol/L), hypo-osmolarity (osmolarity 282 mOsm/kg), hypoproteinemia (serum albumin 35 g/L), oliguria (300 mL/d or 30 mL/h), creatinine 1.1-1.5 mg/dL, and hypovolemic shock. Critical ovarian hyperstimulation syndrome is diagnosed when there is severe ascites or hydrothorax, hematocrit 55%, white cell count 25000/mL, oliguria or anuria, creatinine 1.6 mg/dL, creatinine clearance 50 mL/min, thromboembolism, or acute respiratory distress syndrome. Spontaneous regression occurs over 10 to 14 days in mild-to-moderate cases, but it may take longer if implantation occurs. Moderate OHSS may be followed up by daily telephone calls as a minimum in addition to office visits twice weekly. The evaluation consists of liver function tests, pelvic ultrasound, complete blood count, and coagulation profile. Patients with severe OHSS should be admitted to the hospital for treatment if they suffer from severe abdominal pain, nausea and vomiting, hemoconcentration, severe ascites, profound oliguria or anuria, decrease in blood pressure, tachypnea or dyspnea, light-headedness or syncope, electrolyte disturbances (hyponatremia and hyperkalemia), or abnormal liver function test. The clinical treatment of OHSS depends on its severity, complications, and absence or presence of pregnancy.
  • #1 Ovarian hyperstimulation syndrome: Causes, symptoms, and more
    https://www.medicalnewstoday.com/articles/ovarian-hyperstimulation-syndrome
    Ovarian hyperstimulation syndrome, or OHSS, is a condition that causes the ovaries to swell. It typically occurs as an adverse effect of fertility medications. […] OHSS can vary in severity, being mild, moderate, or severe. The most severe cases can become critical. […] The symptoms of mild OHSS may include: uncomfortable or swollen abdomen, mild nausea and vomiting, mild shortness of breath, diarrhea, enlarged ovaries. […] In addition to the signs and symptoms of mild and moderate OHSS, a person may experience: fluid in the lung cavity, severe shortness of breath, urinating very little or not at all, uncontrollable nausea and vomiting, rapid weight gain, which experts define as more than 1 kilogram in 24 hours, fainting, severe abdominal pain, blood clots. […] Doctors will define OHSS as critical if these symptoms are present: kidney failure, irregular heart rhythm, a blood clot that gets stuck and causes an obstruction, fluid around the heart, increased fluid around the lungs, adult respiratory distress syndrome, which is when the lungs cannot deliver adequate oxygen to the vital organs, sepsis.
  • #1 Ovarian hyperstimulation syndrome | Lima Memorial Health System
    https://www.limamemorial.org/m/health-library/HIE%20Multimedia/1/007294
    Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] The symptoms of OHSS can range from mild to severe. Most women with the condition have mild symptoms such as: 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, Blood clots. […] Most mild cases of OHSS will go away on their own after menstruation starts. If you have a more severe case, it can take several days for symptoms to improve. […] If you become pregnant during OHSS, the symptoms may get worse and can take weeks to go away.
  • #1 9 Crucial Insights About IVF And OHSS Syndrome
    https://positivestepsfertility.com/blog/ivf-and-ohss-syndrome/
    Symptoms of OHSS can range from mild to severe. Mild symptoms include bloating, mild abdominal pain, and nausea. In moderate cases, the symptoms can escalate to more significant abdominal pain, vomiting, and diarrhea. Severe OHSS can result in rapid weight gain, severe abdominal pain, shortness of breath, and decreased urine output. Its essential to monitor these symptoms closely and seek medical advice if they worsen. […] The duration of OHSS varies depending on the severity of the condition. Mild cases of OHSS typically resolve within a week or two without the need for extensive medical intervention. However, more severe cases can last longer and may require hospitalization and medical treatment to manage symptoms and prevent complications. […] OHSS can develop soon after egg retrieval, often within a few days. Symptoms can start to appear as early as three to five days post-retrieval and can continue to develop for up to two weeks. The timing and severity of symptoms can vary among individuals. Close monitoring during this period is essential to catch any signs of OHSS early and manage them effectively.
  • #1 Treating Ovarian Hyperstimulation Syndrome | Progyny
    https://progyny.com/education/fertility-medication/treating-ovarian-hyperstimulation-syndrome/
    The symptoms of OHSS are caused by the fluids and substances released from over-stimulated ovaries. The fluid is shifted from the circulatory system (where it belongs) into the abdomen. The extra fluid results in weight gain and abdominal distension. […] The majority of ovarian hyperstimulation syndrome cases are mild and require no treatment except for drinking extra fluids. However, mild OHSS can develop into moderate or severe OHSS. […] Typically, OHSS will go away about a week after controlled ovarian hyperstimulation is stopped, but if you are pregnant, the symptoms may last anywhere from 10 to 30 days. This is because human chorionic gonadotropin (hCG) worsens the symptoms of OHSS.
  • #1 Ovarian hyperstimulation syndrome (OHSS) patient education fact sheet | ReproductiveFacts.org
    https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-hyperstimulation-syndrome-ohss/
    In all cases of OHSS, the ovaries are enlarged. The size of the ovary is a marker of the degree of OHSS. If symptoms are present, a transvaginal or abdominal ultrasound can be done to measure ovary size and the amount of fluid that has been collected. […] OHSS symptoms usually start a few days after ovulation. Symptoms usually resolve within two weeks unless pregnancy occurs. Pregnant individuals often continue to have symptoms for 2-3 weeks or more after a positive pregnancy test. The symptoms gradually go away, and the rest of the pregnancy is not affected. […] Severe OHSS (continued vomiting, severe swelling of the abdomen, shortness of breath, inability to drink fluids, or abnormal laboratory results) may require hospitalization for intensive monitoring and treatment.
  • #1 Ovarian Hyperstimulation Syndrome (OHSS) | LLU Fertility
    https://lomalindafertility.com/treatments/ivf/about-ovarian-hyperstimulation-syndrome-ohss/
    Typically, OHSS symptoms are minor, with mild to moderate pain, loss of appetite, nausea, diarrhea and feeling bloated. […] In rare cases, worse symptoms can include severe abdominal pain, severe nausea or vomiting, decreased urination, dark-colored urine, shortness of breath, low blood pressure and excessive weight gain. […] Symptoms usually appear four to five days after a womans eggs are collected in the IVF retrieval process. However, symptoms usually resolve spontaneously with the onset of the next period or shortly thereafter. […] If a patient is pregnant when OHSS hits, the symptoms may worsen and last approximately two to three weeks. […] Although very uncommon, severe OHSS symptoms can be treated through hospitalization for intravenous fluid hydration or, in rare circumstances, inserting a needle in the abdomen to remove excess fluid. […] If severe OHSS occurs after conceiving, it can last up to the tenth week of pregnancy and then resolve.
  • #1 Ovarian Hyperstimulation Syndrome: What is OHSS?
    https://drbrighten.com/understanding-ovarian-hyperstimulation-syndrome/
    If you become pregnant with OHSS, symptoms can worsen and last longer, weeks to months. As hCG levels continue to rise and stimulate the ovaries, symptoms can last even until the end of the first trimester. […] If the fertility treatment doesn’t result in a pregnancy, symptoms should resolve by your next period or usually within 10 days.
  • #1 A Guide to OHSS: Symptoms and Management – Femia
    https://femia.health/health-library/getting-pregnant/challenges/ohss-symptoms/
    However, if symptoms worsen, such as significant weight gain, increased abdominal swelling, or difficulty breathing, it’s essential to seek medical care promptly. […] It is important to contact your fertility clinic or emergency services if you experience severe symptoms, including: Difficulty breathing because of a build-up of fluid in your lungs, Reduced urination and dark urine, Blood clots in your legs or lungs. […] Mild cases can be resolved without long-term effects, but severe untreated OHSS often leads to complications like kidney damage and blood clots in rare cases. […] While mild symptoms can often be managed at home with rest, hydration, and close monitoring, it’s critical to contact a healthcare provider if symptoms escalate, such as severe pain, rapid weight gain, or reduced urination. Early OHSS prevention with appropriate treatment can help reduce the risk of complications, ensuring a safer and more effective fertility journey.
  • #1 Understanding Ovarian Hyperstimulation Syndrome: Symptoms, Causes, and Treatments – The Fertility Foundation
    https://fertilityfoundation.org/ovarian-hyperstimulation-syndrome/
    Ovarian Hyperstimulation Syndrome (OHSS) is a condition that can occur in women undergoing fertility treatment, specifically in vitro fertilization (IVF) or ovarian stimulation. […] The symptoms of OHSS can range from mild to severe, depending on the individual case. It is crucial to recognize the signs early on to seek appropriate medical intervention. The symptoms include: Abdominal bloating and discomfort: Women with OHSS often experience a feeling of fullness or bloating in their abdominal region. Ovarian enlargement: The ovaries may become enlarged due to excessive stimulation, causing discomfort or pain in the pelvic area. Fluid retention: Fluid accumulation in the abdominal cavity can lead to weight gain and increased waist circumference. Nausea and vomiting: Some women may experience nausea and vomiting as a result of OHSS. Difficulty breathing: In severe cases, fluid accumulation in the chest cavity can lead to shortness of breath and difficulty breathing.
  • #1 Symptoms of OHSS After Egg Retrieval – Raadina Health
    https://raadinahealth.com/en/blog/ovarian-hyperstimulation-syndrome
    Ovarian hyperstimulation syndrome happens when the ovaries swell and leak. Pain in the lower abdomen, bloating, rapid weight gain, and upset stomach are the main signs of OHSS. […] Severe symptoms of OHSS after egg retrieval include abdominal pain, dyspnea (shortness of breath), and vomiting. […] OHSS usually ranges from mild to moderate, and its severe cases are rare. The mild to moderate symptoms of the condition are temporary and will improve within a week; however, OHSS symptoms worsen if the pregnancy occurs and may last for several weeks. […] Symptoms of mild to moderate OHSS after egg retrieval include: Rapid weight gain to more than 3 kg; Increased waist size; Bloating; Abdominal pain; Nausea and vomiting; Diarrhea; Uterine prolapse. […] Symptoms of severe OHSS include: Extreme rapid weight gain to about 15-20 kg in 10 days; Tight or enlarged abdomen; Ascites (abdominal fluid); Severe abdominal pain; Pelvic pain; Severe and persistent nausea and vomiting; Shortness of breath, cough, and chest pain; High blood concentration; Decreased urination; blood clots in legs; Swelling above the ankle; Dry skin and hair.
  • #1 Ovarian hyperstimulation syndrome – Diagnosis & treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/diagnosis-treatment/drc-20354703
    Ovarian hyperstimulation syndrome diagnosis may be based on: […] If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. […] Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. […] Mild OHSS typically resolves on its own. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. […] Call your provider if your signs and symptoms get worse. […] Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?
  • #1 Ovarian Hyperstimulation Syndrome (OHSS) | University of Iowa Health Care
    https://uihc.org/services/ovarian-hyperstimulation-syndrome-ohss
    OHSS is a problem sometimes seen in women who take fertility medicines to stimulate egg production. […] The ovaries can become very swollen if the medicines stimulate the ovaries too much. Fluid can leak into the belly and chest. This is called OHSS. It happens only after the eggs are released from the ovary (ovulation). […] Signs of OHSS can range from mild to severe. Most women have mild signs, such as: Bloating, Mild pain in the belly, Weight gain. […] In rare cases, women can have more serious signs, such as: Rapid weight gain (5 pounds overnight), Severe pain or swelling in the belly, Less peeing than normal, Feeling short of breath, Nausea, vomiting, or diarrhea. […] Most mild cases go away on their own after menstruation starts. It can take many days to feel better if you have a more severe case. You may get worse and take weeks to feel better if you become pregnant during OHSS. […] In rare cases, OHSS can lead to life-threatening problems, such as: Blood clots, Kidney failure, Severe electrolyte imbalance, Severe fluid buildup in the belly or chest.
  • #1 Ovarian hyperstimulation syndrome (OHSS) | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/
    If you have mild OHSS, you can be looked after at home. […] Call for medical help if you develop any of the symptoms of OHSS, particularly if the pain is not getting any better or if you start to vomit, have urinary problems or chest pain or have difficulty breathing. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. Treatment is to help symptoms and prevent complications. […] To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] You may be at increased risk of developing pre-eclampsia or giving birth to your baby prematurely. However, there are no known risks to your baby’s development as a result of OHSS.
  • #1 All About OHSS (Ovarian Hyperstimulation Syndrome)
    https://www.healthline.com/health/infertility/ohss
    Its important to get immediate treatment if you experience severe symptoms and have any risk factors of OHSS. Issues like blood clots, trouble breathing, and severe pain may lead to more serious complications, like an ovarian cyst rupture with excessive bleeding. […] The majority of OHSS cases are mild versus severe. If you feel youre at risk, share your thoughts and concerns with your healthcare provider. There are a number of things you can do to try and prevent this complication, and your doctor can provide guidance on whats right for you and your body. […] If you do develop OHSS, keep a close eye on your symptoms. Mild cases can resolve on their own with rest and time. Severe cases may land you in the hospital for care. So, if at any point something feels off or wrong, dont hesitate to contact your doctor ASAP.
  • #1 Ovarian hyperstimulation syndrome | VARTA
    https://www.varta.org.au/resources/news-and-blogs/ovarian-hyperstimulation-syndrome-0
    If you’re going through IVF, theres a small risk you will experience ovarian hyperstimulation syndrome (OHSS). […] OHSS is a potentially serious complication of fertility treatment, particularly IVF. When fertility drugs are given to stimulate the ovaries to produce eggs, there can be an excessive response. […] It is normal to have some discomfort after an egg collection procedure. But if you experience any of the following, it could be a sign of OHSS. […] Mild OHSS: mild abdominal swelling, discomfort and nausea. […] Moderate OHSS: symptoms of mild OHSS, but the swelling is worse because of fluid build up in the abdomen. This can cause abdominal pain and vomiting. […] Severe OHSS: symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour and/ or you may experience difficulty breathing because of a build up of fluid in your chest. A serious rare complication is a blood clot in your legs or lungs. The symptoms of this are a swollen, tender leg or pain in your chest and breathlessness.
  • #1 Ovarian Hyperstimulation Syndrome (OHSS) – California IVF Fertility Center Sacramento
    https://www.californiaivf.com/ovarian-hyperstim-ohss/
    OHSS will usually present as mild symptoms fairly early after administration of HCG. […] The symptoms can worsen when a pregnancy occurs. […] In most cases of mild OHSS, symptoms are usually mild and require no treatment other than drinking extra fluids. […] In severe cases, OHSS may result in blood clots, kidney damage, ovarian torsion (twisting), or abdominal and chest fluid collections. […] In pregnancy, OHSS may persist for 10-30 days. […] Patients can have any degree of symptoms and not just mild or severe. […] Mild OHSS: Abdominal Bloating, Mild to Moderate Abdominal Pain, Mild Nausea, 5-10 lb weight gain in 3-5 days. […] Severe OHSS: Severe Abdominal Pain, Decreased Urinary Frequency, Tea-colored Urine, Shortness of Breath, Severe Nausea/Vomiting, >10 lb Weight Gain in 3-5 days.
  • #1 IVF complications: Ovarian hyperstimulation syndrome (OHSS)
    https://www.pfcla.com/blog/ovarian-hyperstimulation-syndrome-ohss-ivf
    Ovarian hyperstimulation syndrome (OHSS) is a severe complication known to occur during IVF treatments. […] The symptoms of OHSS can range from mild to severe, with severe cases resulting in hospitalization if not treated immediately. Intended parents need to look out for these symptoms while undergoing ovarian stimulation treatment during their IVF cycle. […] When a woman suffers from a mild case of OHSS, the common symptoms include: Mild or moderate abdominal pain, Tenderness around the pelvis and ovary area, Bloating, Nausea, Vomiting, Diarrhea, Sudden weight gain exceeding 6 pounds. […] When a woman suffers from a severe case of OHSS, the symptoms include: Severe abdominal pain, Enlarged abdomen, Rapid weight gain of up to 40 pounds, Shortness of breath, Decrease need to urinate. […] Contact your doctor as soon as you experience any of the above symptoms of severe OHSS, as immediate medical attention is necessary.
  • #1 Ovarian hyperstimulation syndrome (OHSS): how to deal with it
    https://theduff.co.uk/ovarian-hyperstimulation-syndrome-ohss-ivf/
    The bad news is that the answer is nothing. Theres absolutely nothing you can do to get rid of or cure OHSS. The good news is that the condition is self-limited: it will run its course, which usually takes around two weeks. […] If youre pregnant and you have late onset OHSS, your symptoms too will be self-limited; its just that itll take a lot longer because it takes longer for the hCG to leave your system. […] If you find yourself on any American message boards or blogs, youll likely find that the advice given to patients there differs in three main ways. […] If you cant drink fluids due to nausea, you may be given an intravenous drip (IV) instead. […] Most doctors advise against it and I would too, if you have anything worse than very mild OHSS. Give your body a chance to recover, and then do a frozen embryo transfer a couple of months later.
  • #1 Ovarian hyperstimulation syndrome: Causes, symptoms, and more
    https://www.medicalnewstoday.com/articles/ovarian-hyperstimulation-syndrome
    The symptoms of OHSS tend to present a few days after ovulation and usually disappear within 2 weeks. […] However, in the event of pregnancy, the symptoms may last for 2-3 weeks following a positive test. They often gradually resolve without affecting the rest of the pregnancy. […] Most people who develop OHSS have only mild or moderate symptoms.
  • #1 Prevention of ovarian hyperstimulation syndrome – UpToDate
    https://www.uptodate.com/contents/prevention-of-ovarian-hyperstimulation-syndrome
    Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation (COH) for assisted reproduction technologies (ART). It is characterized by a broad spectrum of signs and symptoms that includes abdominal distention and discomfort, enlarged ovaries, ascites, and other complications of enhanced vascular permeability. The syndrome can be strictly defined as the shift of serum from the intravascular space to the third space, mainly to the abdominal cavity, in the context of enlarged ovaries due to follicular stimulation. In its very severe form, OHSS is a life-threatening condition. […] The pathophysiology of OHSS is not fully understood, but the pivotal stimulus is typically exposure of granulosa cells from multiple follicles to administration of exogenous human chorionic gonadotropin (hCG) for final follicular maturation. hCG exposure leads to the overproduction of vascular endothelial growth factor (VEGF) by the ovaries, the release of vasoactive-angiogenic substances and increased vascular permeability, and loss of fluid to the third space. Signs and symptoms include enlarged ovaries, ascites, abdominal distention and discomfort, and other complications. […] There are two clinical forms of OHSS, both hCG related: the early-onset form (occurring in the first eight days after hCG administration) and the late-onset form (occurring nine or more days after hCG administration, related to pregnancy-induced hCG production).
  • #2 Ovarian hyperstimulation syndrome – Symptoms & causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697
    Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. […] 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. […] 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. […] 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.
  • #2 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss
    Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] The signs and symptoms of OHSS vary depending on the severity of the condition. Symptoms often begin within a week after using medication to stimulate ovulation, though it can take two weeks for symptoms to develop. […] Symptoms of mild to moderate OHSS include: Abdominal pain. Bloating. Slight weight gain (more than 2 pounds per day). Nausea. […] In more severe cases of OHSS, symptoms may include: Excessive weight gain. Severe nausea and vomiting. Severe abdominal swelling. Difficulty breathing. Blood clots. Decreased urination. Severe abdominal pain.
  • #2 Ovarian hyperstimulation syndrome (OHSS): how to deal with it
    https://theduff.co.uk/ovarian-hyperstimulation-syndrome-ohss-ivf/
    Severe to critical: (about 1% of women who do IVF): You have so much fluid (ascites) that it continues travelling up your body and ends up interfering with your diaphragms ability to move making breathing difficult. […] When will the symptoms of OHSS appear? There are two time periods during which you can start to experience symptoms: With early onset OHSS, symptoms can appear within 24 hours of the hCG trigger, but it often takes anywhere up to nine days before they become really apparent. […] If you get early onset OHSS, youre very likely to also get late onset OHSS and late onset OHSS tends to be more severe and more longlasting (up to 12 weeks, at which point the bodys natural hCG levels begin to die down). […] What are the symptoms of OHSS? […] You experience significant weight gain caused by the fluid build-up (approximately 1 kg per day or more).
  • #2 Ovarian hyperstimulation syndrome (OHSS)
    https://www.nuffieldhealth.com/conditions/ovarian-hyperstimulation-syndrome-ohss
    Ovarian hyperstimulation syndrome (OHSS) can be a side effect from Follicle Stimulating Hormone (FSH) injections used in IVF and ICSI treatments. […] OHSS occurs when your ovaries over-respond to FSH injections. FSH injections stimulate your ovaries to produce many egg sacs (follicles). When a large number of follicles are produced it is possible that your ovaries will enlarge and release chemicals into your bloodstream that make blood vessels leak fluid into the body. […] OHSS is classified as mild, moderate or severe. […] Mild OHSS – abdominal swelling, feeling bloated, nausea, heartburn or indigestion […] Moderate OHSS – the symptoms of mild OHSS increase as fluid may be building up in the abdomen. There is increased abdominal pain and vomiting […] Severe OHSS – the most severe form of OHSS only occurs in 1 1.5% of patients. It is characterised by nausea, vomiting, ovarian enlargement and ascites, causing marked abdominal pain and distention. The abdominal distention may prevent the proper movement of the diaphragm (the muscle between the chest and abdomen) so that you feel extremely breathless. You may feel weak and faint due to a reduction in circulating blood volume (hypovolaemia). In the most extreme situations there is a reduction in the blood flow through the kidneys, resulting in a reduction in urine output. If this occurs it may lead to renal failure requiring treatment with renal dialysis.
  • #2 Understanding ovarian hyperstimulation syndrome | Methodist Health System | Omaha, Council Bluffs, Fremont
    https://bestcare.org/news/understanding-ovarian-hyperstimulation-syndrome
    OHSS, a condition characterized by ovarian enlargement with or without abdominal distension and discomfort, occurs when a womans ovaries have an exaggerated response to fertility medication designed to induce oocyte or egg development (controlled ovarian stimulation). […] Symptoms can include: Nausea and/or vomiting, Abdominal bloating and/or discomfort, Fluid buildup in the pelvis or abdomen, Rapid weight gain, Shortness of breath, Decreased urine output, Blood abnormalities and clots. […] Patients with severe OHSS, which occurs in 0.1 to 0.2% of cycles, may experience rapid weight gain, decreased urine output and severe abdominal pain. Blood clots in the legs are a rare complication. […] Severe OHSS usually warrants a trip to the hospital for monitoring and IV fluids. In some cases, anticoagulation medication may be prescribed and paracentesis or aspiration of pelvic or abdominal fluid may be necessary.
  • #2
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5993897/
    Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction that usually occurs after gonadotropin stimulation, followed by human chorionic gonadotropin administration, for infertility treatment. The clinical manifestations and characteristics of mild, moderate, severe, and critical forms of the syndrome are defined. Severe OHSS, which two decades ago was considered an iatrogenic life-threatening condition, can now be effectively prevented or managed during the early stages. The hallmark of OHSS is an increase in the permeability of the capillaries, resulting in a fluid shift form the intravascular space to the extravascular compartments. The main event in the pathogenesis of OHSS is ovarian enlargement, secretion of vasoactive substances, ascites, and hypovolemia resulting from an acute extravasation of fluid into the interstitial space. OHSS is classified into 4 categories based on the severity of symptoms, signs, and laboratory findings. Mild ovarian hyperstimulation syndrome is defined by the enlargement of bilateral ovaries with multiple follicular and corpus luteal cysts, measuring up to 8 cm and accompanied by abdominal bloating and mild abdominal pain. Moderate ovarian hyperstimulation syndrome is characterized by the enlargement of the ovaries up to 12 cm, accompanied by abdominal bloating due to an increase in ovarian size and gastrointestinal symptoms (e.g., nausea, vomiting, and diarrhea) as well as ultrasound evidence of ascites. Severe ovarian hyperstimulation syndrome is described by the presence of large ovarian cysts (1212 cm), clinical ascites with or without hydrothorax, hyperkalemia (potassium 5 mmol/L), hyponatremia (sodium 135 mmol/L), hypo-osmolarity (osmolarity 282 mOsm/kg), hypoproteinemia (serum albumin 35 g/L), oliguria (300 mL/d or 30 mL/h), creatinine 1.1-1.5 mg/dL, and hypovolemic shock. Critical ovarian hyperstimulation syndrome is diagnosed when there is severe ascites or hydrothorax, hematocrit 55%, white cell count 25000/mL, oliguria or anuria, creatinine 1.6 mg/dL, creatinine clearance 50 mL/min, thromboembolism, or acute respiratory distress syndrome. Spontaneous regression occurs over 10 to 14 days in mild-to-moderate cases, but it may take longer if implantation occurs. Moderate OHSS may be followed up by daily telephone calls as a minimum in addition to office visits twice weekly. The evaluation consists of liver function tests, pelvic ultrasound, complete blood count, and coagulation profile. Patients with severe OHSS should be admitted to the hospital for treatment if they suffer from severe abdominal pain, nausea and vomiting, hemoconcentration, severe ascites, profound oliguria or anuria, decrease in blood pressure, tachypnea or dyspnea, light-headedness or syncope, electrolyte disturbances (hyponatremia and hyperkalemia), or abnormal liver function test. The clinical treatment of OHSS depends on its severity, complications, and absence or presence of pregnancy.
  • #2 Ovarian hyperstimulation syndrome | VARTA
    https://www.varta.org.au/resources/news-and-blogs/ovarian-hyperstimulation-syndrome-0
    Most of your symptoms should resolve in seven to 10 days. If your treatment does not result in a pregnancy, OHSS usually gets better by the time your next period starts. If you become pregnant, OHSS can get worse and last up to a few weeks or longer. […] While no treatment can reverse OHSS, it will usually get better with time.
  • #2 Ovarian hyperstimulation syndrome (OHSS) | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/
    OHSS can range from mild to severe: […] Mild OHSS is common and usually gets better with time. More severe cases require specialist care and hospital admission. […] It is normal to have some mild discomfort after egg collection. If you are worried or develop any of the symptoms below, you should seek medical advice. […] Mild OHSS: mild abdominal swelling, discomfort and nausea. […] Moderate OHSS: symptoms of mild OHSS, but the swelling is worse because of fluid build-up in the abdomen. This can cause abdominal pain and vomiting. […] Severe OHSS: symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour and/or you may experience difficulty breathing because of a build-up of fluid in your chest. […] Most of your symptoms should resolve in 7-10 days. If your fertility treatment does not result in a pregnancy, OHSS usually gets better by the time your next period starts. If you become pregnant, OHSS can get worse and last up to a few weeks or longer.
  • #2 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss
    Women at a higher risk for OHSS include those who have PCOS. […] Women with OHSS are at risk for developing a thrombosis (blood clot) in the lungs or legs. […] The treatment for OHSS varies depending on how severe the condition is. Treatment aims to manage symptoms and avoid complications. Mild cases tend to go away within a week or two. […] Severe cases of OHSS often require hospitalization. […] OHSS is temporary. The condition typically goes away within two weeks. Even severe cases have a positive outlook when you receive prompt treatment. […] Yes, having OHSS doesnt impact your pregnancy. Your symptoms will eventually go away and your pregnancy is unaffected.
  • #2 Ovarian Hyperstimulation Syndrome and Pregnancy: OHSS Treatment and IVF Complete Guide
    https://www.asianinfertility.com/blog/ovarian-hyperstimulation-syndrome-and-pregnancy
    Symptoms of OHSS include intense abdominal pain, tightness, and difficulty breathing even when sitting or standing. Patients may also experience rapid weight gain, a significant decrease in urine output, dizziness, and low blood pressure. But it is left untreated, then brain fog, confusion, or altered mental status may occur. […] During Early Symptoms, patients may notice mild abdominal discomfort, bloating, and nausea. Some may experience diarrhea and a slight increase in weight due to fluid retention. […] During Progressive Symptoms, the discomfort becomes more pronounced, accompanied by persistent nausea and vomiting. Rapid weight gain and increased abdominal size may occur, along with difficulty breathing, especially when lying flat. […] Severe OHSS requires immediate medical attention and hospitalization for close monitoring and intensive management. In extreme cases, drainage of fluid from the abdomen (paracentesis) or chest (thoracentesis) may be necessary to relieve symptoms and prevent complications.
  • #2 Ovarian hyperstimulation syndrome: Causes, symptoms, and more
    https://www.medicalnewstoday.com/articles/ovarian-hyperstimulation-syndrome
    Ovarian hyperstimulation syndrome, or OHSS, is a condition that causes the ovaries to swell. It typically occurs as an adverse effect of fertility medications. […] OHSS can vary in severity, being mild, moderate, or severe. The most severe cases can become critical. […] The symptoms of mild OHSS may include: uncomfortable or swollen abdomen, mild nausea and vomiting, mild shortness of breath, diarrhea, enlarged ovaries. […] In addition to the signs and symptoms of mild and moderate OHSS, a person may experience: fluid in the lung cavity, severe shortness of breath, urinating very little or not at all, uncontrollable nausea and vomiting, rapid weight gain, which experts define as more than 1 kilogram in 24 hours, fainting, severe abdominal pain, blood clots. […] Doctors will define OHSS as critical if these symptoms are present: kidney failure, irregular heart rhythm, a blood clot that gets stuck and causes an obstruction, fluid around the heart, increased fluid around the lungs, adult respiratory distress syndrome, which is when the lungs cannot deliver adequate oxygen to the vital organs, sepsis.
  • #2 Ovarian hyperstimulation syndrome
    https://pmc.ncbi.nlm.nih.gov/articles/PMC3205536/
    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology. The syndrome is characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to increased capillary permeability and ovarian neoangiogenesis. Enlargement of the ovaries causes abdominal pain, nausea and vomiting. Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium. The incidence of moderate OHSS is estimated to be between 3 and 6%, while the severe form may occur in 0.1-3% of all cycles. OHSS has been recognized in two forms: The early form of OHSS, (within days after the ovulation triggering injection of hCG) although elicited by hCG, is related to an exaggerated ovarian response to gonadotrophin stimulation, whereas the late form (10 days after hCG) is mainly related to the secretion of placental hCG. The enlargement is sometimes as much as 25 cm. Another consequence is discomfort resulting from increased intra-abdominal pressure due to ascites. Leakage of fluid from follicles, increased capillary permeability leading to third spacing (due to the release of vasoactive substances), or frank rupture of follicles can all cause ascites. Due to leakage of fluid through the impaired blood vessels both within and outside the ovary there is massive fluid-shift from the intra-vesicular bed to the third compartment results in intravascular hypovolemia with concomitant development of edema, ascites, hydrothorax and/or hydropericardium. The hypovolemia of OHSS leads to hemoconcentration and creates a hypercoagulable state. Acute renal failure may result. Severe and critical forms of OHSS are potentially lethal disorders, and history taking and physical examination are paramount at the time of admission. After several days, third-space fluid begins to re-enter the intravascular space, hemoconcentration reverses and natural diuresis ensues. Complete resolution typically takes 10-14 days from the onset of initial symptoms.
  • #2 Ovarian hyperstimulation syndrome (OHSS) | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/
    If you have mild OHSS, you can be looked after at home. […] Call for medical help if you develop any of the symptoms of OHSS, particularly if the pain is not getting any better or if you start to vomit, have urinary problems or chest pain or have difficulty breathing. […] Although there is no treatment that can reverse OHSS, it will usually get better with time. Treatment is to help symptoms and prevent complications. […] To lower the risk of developing a blood clot in your legs or lungs, you will be advised to continue wearing support stockings and taking heparin (blood-thinning) injections until 12 weeks of your pregnancy. […] You may be at increased risk of developing pre-eclampsia or giving birth to your baby prematurely. However, there are no known risks to your baby’s development as a result of OHSS.
  • #2 A Guide to OHSS: Symptoms and Management – Femia
    https://femia.health/health-library/getting-pregnant/challenges/ohss-symptoms/
    However, if symptoms worsen, such as significant weight gain, increased abdominal swelling, or difficulty breathing, it’s essential to seek medical care promptly. […] It is important to contact your fertility clinic or emergency services if you experience severe symptoms, including: Difficulty breathing because of a build-up of fluid in your lungs, Reduced urination and dark urine, Blood clots in your legs or lungs. […] Mild cases can be resolved without long-term effects, but severe untreated OHSS often leads to complications like kidney damage and blood clots in rare cases. […] While mild symptoms can often be managed at home with rest, hydration, and close monitoring, it’s critical to contact a healthcare provider if symptoms escalate, such as severe pain, rapid weight gain, or reduced urination. Early OHSS prevention with appropriate treatment can help reduce the risk of complications, ensuring a safer and more effective fertility journey.
  • #2 Ovarian hyperstimulation syndrome // Middlesex Health
    https://middlesexhealth.org/learning-center/diseases-and-conditions/ovarian-hyperstimulation-syndrome
    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. […] 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 OHSS typically resolves on its own. Treatment for moderate OHSS may involve: Increased fluid intake, 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, Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity, Medications to prevent blood clots (anticoagulants).
  • #2 Ovarian Hyperstimulation Syndrome Workup: Approach Considerations
    https://emedicine.medscape.com/article/1343572-workup
    In ovarian hyperstimulation syndrome (OHSS), the hematocrit is the most important measure in deciding if a patient should be hospitalized. If the patient’s hematocrit level is greater than 60% and if she has ascites, hospitalize her immediately. […] Signs that may indicate a progression in the severity of OHSS are increases in the hCG level, increases in hematocrit level, hypoproteinemia, and hypoalbuminemia (third spacing). Additional signs are decreasing renal and liver function. […] OHSS is critical when the signs and symptoms of severe OHSS are present with any of the following findings: renal failure, ARDS, thromboembolism, or a hematocrit level greater than 60%.
  • #2 Ovarian hyperstimulation syndrome – Diagnosis & treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/diagnosis-treatment/drc-20354703
    Ovarian hyperstimulation syndrome diagnosis may be based on: […] If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. […] Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you’re pregnant. […] Mild OHSS typically resolves on its own. […] With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. […] Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. […] If you develop mild ovarian hyperstimulation syndrome, you’ll probably be able to continue your day-to-day routine. […] Call your provider if your signs and symptoms get worse. […] Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?
  • #2 Ovarian Hyperstimulation Syndrome, OHSS | Blog
    https://www.advancedfertility.com/blog/ovarian-hyperstimulation-syndrome-ohss
    Ovarian hyperstimulation syndrome, or OHSS, is a condition that occurs when the ovaries become enlarged and fluid accumulates in the abdominal cavity. This condition typically appears a few days after egg retrieval or in early pregnancy. […] Common OHSS Symptoms: Lower abdominal distention (bloating), Abdominal pain, Nausea and possible vomiting, Diarrhea, Difficulty breathing due to pressure on the diaphragm from the ovaries and fluid buildup. […] Mild OHSS is common and affects up to 35% of women undergoing ovarian stimulation. Mild and moderate cases are managed through observation, exams, and sometimes blood work, while severe cases may require hospitalization or paracentesis (removal of excess abdominal fluid). […] Severe OHSS may necessitate hospitalization under the following conditions: Severe abdominal pain, Severe nausea and vomiting, Very low blood pressure, Severe blood test abnormalities, Extremely low urine output. […] Paracentesis is sometimes performed for moderate to severe OHSS cases to relieve symptoms by draining fluid from the abdomen. […] OHSS prevention involves careful use of injectable FSH medications, especially for those at higher risk.
  • #3 Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment
    https://my.clevelandclinic.org/health/diseases/17972-ovarian-hyperstimulation-syndrome-ohss
    Ovarian hyperstimulation syndrome (OHSS) happens when your ovaries swell and leak fluid into your abdomen. OHSS is a complication that typically occurs in women who receive fertility treatments that stimulate their ovaries to produce a large number of eggs. […] The signs and symptoms of OHSS vary depending on the severity of the condition. Symptoms often begin within a week after using medication to stimulate ovulation, though it can take two weeks for symptoms to develop. […] Symptoms of mild to moderate OHSS include: Abdominal pain. Bloating. Slight weight gain (more than 2 pounds per day). Nausea. […] In more severe cases of OHSS, symptoms may include: Excessive weight gain. Severe nausea and vomiting. Severe abdominal swelling. Difficulty breathing. Blood clots. Decreased urination. Severe abdominal pain.
  • #3 Ovarian hyperstimulation syndrome | Lima Memorial Health System
    https://www.limamemorial.org/m/health-library/HIE%20Multimedia/1/007294
    Ovarian hyperstimulation syndrome (OHSS) is a problem that is sometimes seen in women who take fertility medicines that stimulate egg production. […] The symptoms of OHSS can range from mild to severe. Most women with the condition have mild symptoms such as: 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, Blood clots. […] Most mild cases of OHSS will go away on their own after menstruation starts. If you have a more severe case, it can take several days for symptoms to improve. […] If you become pregnant during OHSS, the symptoms may get worse and can take weeks to go away.
  • #3 Ovarian hyperstimulation syndrome (OHSS) | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ovarian-hyperstimulation-syndrome/
    OHSS can range from mild to severe: […] Mild OHSS is common and usually gets better with time. More severe cases require specialist care and hospital admission. […] It is normal to have some mild discomfort after egg collection. If you are worried or develop any of the symptoms below, you should seek medical advice. […] Mild OHSS: mild abdominal swelling, discomfort and nausea. […] Moderate OHSS: symptoms of mild OHSS, but the swelling is worse because of fluid build-up in the abdomen. This can cause abdominal pain and vomiting. […] Severe OHSS: symptoms of moderate OHSS with extreme thirst and dehydration. You may only pass small amounts of urine which is dark in colour and/or you may experience difficulty breathing because of a build-up of fluid in your chest. […] Most of your symptoms should resolve in 7-10 days. If your fertility treatment does not result in a pregnancy, OHSS usually gets better by the time your next period starts. If you become pregnant, OHSS can get worse and last up to a few weeks or longer.

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