04:33 29th August 2013 | In-Vitro Fertilisation

Under Response Over Response Follicles FSH OHSS Ovarian Hyperstimulation Syndrome HCG Injection Abdominal Pain

Under response
Sometimes the ovaries respond inadequately to the drugs and produce very few, if any follicles. If the woman is already on the maximum dose of FSH then a decision will be made as to whether the treatment cycle is to be continued in spite of the very poor chance of success, or cancelled. If the latter option is chosen the couple will be offered a consultation to see a doctor during which other treatment options will be discussed. If the woman is not on the maximum dose of FSH, the cycle may be cancelled and a further attempt arranged with an increased dose of FSH.

Over response
Severe ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of the use of FSH treatment. Usually it only occurs if large numbers of follicles (i.e more than 20) have developed in the ovaries. We try to avoid OHSS by choosing the lowest dose of FSH that will produce adequate numbers of eggs. However, the response of different women to these drugs is very unpredictable, particularly in those women with polycystic ovaries by blood tests and scans. When a large number of follicles develop, we have two options: we may decide to abandon the cycle before hCG injection and start again at a later date with a lower dose of FSH. Alternatively we may, having reminded you of the risks, continue the cycle, taking particular care to empty all follicles at egg collection. It does seem that if great care is taken during egg collection to drain all the follicles, the severity of OHSS is reduced. However problems may still arise despite all our care. Symptoms usually commence around 4 – 5 days after hCG injection and usually start with pain and swelling of the abdomen. The ovaries become very large and surrounded by fluid and the woman may start to vomit. Loss of fluid in this way may lead to dehydration which can lead to concentration of the blood and to the formation of clots. This can be very serious. It must be stressed that this is very rare and the following precautions will be taken.

1. Women who have developed large numbers of follicles will be made aware that there is a risk they will develop this syndrome, and be given the option to abandon the cycle before hCG.
2. Any woman having abdominal pain that increases rather than settles a day or two after egg collection should inform the clinic. You will be advised on whether it is safe for you to stay at home or whether you should come to the clinic.
3. It is particularly important to let us know of the development of any nausea and vomiting. When this happens, the woman will probably be asked to return to the clinic for assessment.
4. If the situation is not severe, we will probably ask the woman to return in a day or two for further assessment.
5. If the condition is severe, arrangements will be made for the woman to be admitted and have an intravenous drip inserted to reduce the dehydration. It may also be necessary to insert a tube into the abdomen to drain the fluid that causes the swelling. Some women may be given anti coagulant therapy such as Heparin injection.

By carrying out these precautions, we hope that a dangerous situation will be averted. It should be added that OHSS does not mean that the treatment has not worked. It is not uncommon for women with these symptoms to be pregnant, and once the symptoms have subsided, the pregnancy should proceed entirely normally.

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