How is OHSS treated in IVF?

How is OHSS treated in IVF?

OHSS causes the ovaries to become enlarged and can cause the blood vessels to leak fluid into the abdomen, chest, or other parts of the body. Severe OHSS can be life-threatening and requires immediate medical attention.

Women with PCOS are at a higher risk for developing OHSS, as they already have a hormonal imbalance that affects their ovaries. The risk of developing OHSS can be reduced by closely monitoring hormone levels and adjusting medication doses. If the condition is severe, hospitalization may be required to control the symptoms and prevent any complications.

Advances in fertility medication protocols and monitoring techniques have greatly reduced the incidence of severe OHSS. It is important for women undergoing fertility treatments to be aware of the signs and symptoms of OHSS and to communicate any concerns with their healthcare provider. Early recognition and treatment can help prevent serious complications and ensure the best possible outcome.

What causes ovarian hyperstimulation syndrome (OHSS)?

OHSS typically occurs as a result of fertility treatments that induce the production of multiple eggs simultaneously, leading to elevated levels of the pregnancy hormone hCG. This hormone can cause the blood vessels surrounding the ovaries to leak fluid, resulting in swelling. However, there are rare cases where genetic mutations in hormone receptors can also lead to OHSS without the use of fertility treatments. The swelling caused by the excess fluid can lead to a variety of symptoms, including pain, nausea, vomiting, increased thirst, and swelling. In severe cases, the excess fluid can cause breathing difficulties and reduced urination.

What are the symptoms of OHSS? 

The symptoms of ovarian hyperstimulation syndrome (OHSS) can vary in severity, from mild to severe. Mild symptoms may include bloating, abdominal discomfort, and nausea. Other common symptoms include:

  • Diarrhea
  • Vomiting
  • Decreased appetite
  • Weight gain
  • Frequent urination
  • Thirst
  • Shortness of breath
  • Chest pain
  • Rapid heartbeat

Severe OHSS can be life-threatening and may require hospitalization. Symptoms of severe OHSS include:

  • Severe abdominal pain
  • Sudden and severe swelling of the hands, legs, or stomach
  • Dizziness or fainting
  • Dark urine or decreased urine output
  • Shortness of breath or difficulty breathing
  • Confusion or disorientation

It is important for women undergoing fertility treatments to be aware of the signs and symptoms of OHSS and to report any concerns to their healthcare provider. Early recognition and treatment can help prevent serious complications and ensure the best possible outcome. 

How is ovarian hyperstimulation syndrome (OHSS) treated?

The treatment for ovarian hyperstimulation syndrome (OHSS) depends on the severity of the symptoms. Mild cases of OHSS typically resolve on their own within a few days to a week without any specific treatment other than monitoring and rest.

For moderate to severe cases of OHSS, treatment may include:

  • Hydration: Drinking plenty of fluids, including electrolyte solutions, to maintain hydration and prevent electrolyte imbalances.
  • Medications: Medications to help manage symptoms may include pain relievers for abdominal pain, anti-nausea medications, and blood thinners to prevent blood clots.
  • Monitoring: Close monitoring of vital signs, fluid balance, electrolyte levels, and organ function is essential to ensure that the patient is not developing any complications.
  • Hospitalization: In severe cases of OHSS, hospitalization may be necessary to provide more intensive monitoring and treatment, such as intravenous fluids, electrolyte replacement, and oxygen therapy.
  • Ovarian puncture: In some cases, the fluid-filled cysts that have developed on the ovaries may need to be drained through a procedure called ovarian puncture.
  • Cancellation of fertility treatment: In some cases, fertility treatment may need to be stopped or postponed to allow the body to recover from OHSS.

It is important to note that OHSS can be a serious and potentially life-threatening condition. Women undergoing fertility treatments should be closely monitored for symptoms of OHSS, and any concerns should be reported to their healthcare provider immediately. Early recognition and treatment can help prevent serious complications and ensure the best possible outcome. (5)

How can you prevent OHSS?

Preventing OHSS during IVF treatment involves several strategic approaches.

  • Firstly, adjusting medications plays a crucial role. Fertility experts tailor gonadotropin doses, ensuring stimulation remains at safe levels. They meticulously monitor ovarian response, adjusting doses as needed to prevent overstimulation.
  • Secondly, coasting temporarily halts medication, allowing follicles to reach maturity at a controlled pace. This method significantly reduces the chances of excessive ovarian stimulation.
  • Thirdly, opting for a GnRH agonist as a trigger shot presents a viable alternative for high-risk individuals. Unlike hCG, GnRH agonists carry a lesser risk of triggering fluid accumulation, making them a safer choice.
  • Additionally, adopting a selective egg retrieval technique minimizes hormonal fluctuations. By aspirating only mature eggs and leaving others, the risk associated with OHSS decreases.
  • Finally, embracing frozen embryo transfer (FET) is beneficial. This approach involves freezing eggs post-retrieval and transferring embryos in a subsequent cycle. It allows the ovaries ample time to recuperate and reduces exposure to hCG, consequently lowering OHSS risk.

Implementing these methods effectively minimizes the occurrence of OHSS, enhancing the safety and success of IVF treatments.


Devroey, P., Polyzos, N. P., & Blockeel, C. (2011). An OHSS-Free Clinic by segmentation of IVF treatmentHuman reproduction26(10), 2593-2597.

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