IVF is a treatment that assists reproduction. In order to increase the chance of pregnancy, the name IVF treatment is used for all procedures performed to observe the growth, proliferation and maturation of the egg with external help, namely with drugs, and to fertilize it with sperm. For patients who cannot get pregnant naturally, the reason for this should first be investigated and then treatments should be applied to eliminate the problem found. In some old techniques, some high-dose drugs applied to obtain quality eggs have caused unhealthy eggs to be obtained, contrary to quality.
A part of IVF treatment is ovarian stimulating hormones. This is the second stage of the treatment. The aim is to control the body's own egg production structure, stimulate the ovaries with externally administered hormone injections and ensure the development of the sacs containing egg cells (follicles). The number of follicles being more than necessary or less than necessary is a condition that affects the treatment in itself. The process before starting the treatment is of great importance for all these reasons. Some information is needed to determine the dose of hormone injections, including the patient's age and weight and previous treatments. As the sacs grow (follicles), the estrogen level in the blood increases and of course the dose of hormone injections is adjusted with regular tests. In some cases, progesterone hormone should also be measured. Tests can be done daily or every other day. In a period exceeding a week, the sacs that have reached their largest size are put into the maturation process with a rupture needle and after 2 days, the ovaries are collected with a small operation and delivered to the laboratory.
It is only necessary to know that there is no guarantee that eggs will come from the follicles seen on ultrasound. The number of follicles is not the same in all patients. Even if some of our patients use very high doses of hormone injections, a small number of follicles may develop and none of them may produce eggs. Conversely, in patients using low doses of hormone injections, a large number of follicles may develop and more eggs may be produced.
Generally, it is possible for a situation like the one we mentioned at the beginning to occur in older patients and these patients should be told that the success rate is low when starting the treatment. It is also harmful for the ovaries to react excessively and grow too much, which already causes OHSS. It is the most serious event that can occur in IVF treatment.
One of the symptoms that you may experience is OHSS. That is, overstimulation of the ovaries. This disease is more common in women who use stimulating hormones for eggs in the treatment. When these hormones increase more than necessary, the patient experiences some side effects due to the effect of the excess hormone secreted from the eggs, this is called hyperstimulation syndrome. It is more common in women under the age of 35 and thin.
This syndrome, also known as OHSS, is more common in IVF treatment, where the ovaries are stimulated with drugs. It is also seen in patients who have used artificial insemination and in patients who have ovulation indications, although the disease usually occurs in patients who are undergoing IVF treatment. It is a life-threatening disease. It is divided into 3 categories: mild, moderate, and severe. In mild cases, abdominal swelling, weight gain, pain, nausea, and vomiting may be observed.
If it is severe, it causes problems such as excessive swelling of the abdomen, severe abdominal pain, shortness of breath, weight gain, and decreased urine output. If you are undergoing IVF treatment, you may feel some minor OHSS symptoms. These usually do not affect daily life, but we can list the serious symptoms as follows;
Nausea and vomiting
Marked abdominal distension
Water accumulation in the lungs
Staying hydrated
Risk of blood clots
Difficulty breathing
Severe pain in the lower abdomen
Low blood pressure
As the severity of the problems increases, fluid accumulation in the chest cavity, decrease in blood volume and organ failure follow. The cause of the disease is still not fully understood, but one of the most important reasons is that the patient's vascular permeability increases after HGC is applied with an increased estradiol level. Thus, vascular fluids tend to leak out and begin to accumulate in the abdominal cavity. In order for the symptoms to be experienced very seriously, a high level of egg formation must occur. Hormones produced by the ovaries and some organs affect the permeability of blood cells, which is why fluid accumulates in places where it should not be. Since stimulation will be very easy in PCOS syndromes in IVF treatments, the dosage of the drug is very important and should be adjusted very carefully. The main purpose of frequent E2 measurements is to prevent OHSS. If you have mild OHSS, long rests, painkillers, plenty of fluid intake, and frequent but small meals will be enough for you.
If it is severe or moderate, inpatient treatment should be applied. External fluid supplements should definitely be made to the body. Nausea and vomiting should be treated with medication or injections given under the supervision of a doctor. Heparin injection is recommended against the risk of blood clotting.
Paracentesis as a treatment method is the process of removing fluid from the abdominal cavity. It is one of the most beneficial treatments in severe cases.
If OHSS does not occur during pregnancy, it usually decreases and disappears within 1 week. If our patient is pregnant, these symptoms are observed continuously for a period of 2 or 3 weeks. Again, if this condition is not severe, it disappears on its own and does not negatively affect the pregnancy.
The ovaries in OHSS syndrome are sensitive like a sponge and grow like a sponge that has absorbed water, this growth puts pressure on the ovarian capsule and the patient begins to complain of pain. The extremely sensitive ovaries are so affected by even the slightest trauma that they cause small bleedings and can turn around themselves, causing discomfort that requires surgical intervention.
There are small precautions that can be taken to prevent it. For example, stopping the use of egg-enhancing drugs, reducing the dose of the cracking needles used, not performing egg collection (OPU) or, if performed, giving the patient additional special fluids (HSA, HES) intravenously, not performing embryo transfer after egg collection, and if embryo transfer is not cancelled, at least reducing this number and preventing the risk of multiple pregnancy can be listed as factors.
Hyperstimulation Syndrome should never cause panic in patients who have applied to IVF treatment to have a baby. On the contrary, this disease causes an increase in the number of eggs, and this is the general purpose of IVF treatment. Unfortunately, it is not a condition that can be predicted in which patients who start IVF treatment will develop OHSS, it is a disease that can only be prevented by taking small precautions from the moment the disease begins.
In younger age group patients, the ovaries may react more to hormone injections because their ovaries are healthier. It is also more common in women with polycystic ovary disease. If there is a previous OHSS disease, it may be easy to trigger. In other words, it should be kept under control and the disease should be monitored by a doctor, but what we want to say is that this syndrome will not add any negative situation to your baby treatment. Your doctor will apply the most appropriate treatment method for you according to your symptoms and the severity of the symptoms. Our recommendation to you is to prepare yourself psychologically against all the negative and positive things that may occur before starting IVF treatment and to definitely choose a doctor who is an expert in his field. When you start treatment, perform the necessary checks, especially to avoid a syndrome like OHSS.
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