Are you preparing for an egg freezing or IVF retrieval? You’ve done all the legwork with your fertility doctors, ordered your meds and are following healthy lifestyle practices to maximize success like . . .
Getting acupuncture
Taking your supplements
Sticking to a clean diet
Reducing stress
With all these in place, we hope you’ll have a great outcome! But have you thought about what happens after the retrieval? Here at DHH, we want to keep you healthy leading up to and following the procedure. While some patients get back into the swing of things the day after the retrieval, others may be surprised that the recovery is tougher than they expected. This can especially be the case if you experience even a mild form of Ovarian Hyperstimulation Syndrome (OHSS).
What is Ovarian Hyperstimulation Syndrome (OHSS)?
OHSS is an exaggerated response to the medications used to stimulate egg growth or maturation. The ovaries get very swollen and fluid can leak into the abdomen, causing problems. Severe cases are rare (3-8%), but mild cases occur in 1 in 3 IVF patients. It’s important to be checked out and treated for OHSS as severe cases have serious health implications and can even be fatal.
What signs should I look for?
This is not an exhaustive list, but some tell-tale signs are:
Abdominal pain or cramping
Bloating
GI changes like nausea, vomiting or diarrhea
Discomfort around your ovaries
Weight gain or an increase in your waist measurement
Feeling lethargic
Okay, so how can I prevent this?
It’s important to know if you’re at greater risk for developing OHSS. Those at highest risk
Are under age 30 (or 35 according to some sources)
Have a low BMI (<25)
Have a high Antral Follicle Count (>20)
Have a high AMH (>3.5ng/mL)
Have high estrogen levels during the cycle
Have a history of OHSS or PCOS
If you fall into one or more of these categories, talk to your fertility doctor about how they plan to prevent OHSS or treat it if it arises.
“Salty water” and other tips
Besides asking your Reproductive Endocrinologist the right questions, you can decrease the likelihood of getting OHSS with proper diet and hydration. One of my favorite fertility MDs, Dr. Aimee Eyvazzadeh, says to drink “salty water” which is her way of saying electrolyte-rich drinks. My pick would be coconut water, but you can also opt for a healthy electrolyte drink or add electrolyte drops or tablets to your water. A higher sodium diet is also recommended (think of salting your food a little extra and having some salty snacks). While it may seem counterintuitive, being well-hydrated actually decreases bloating; making the rest of your body salty with electrolytes will pull excess fluid from the ovaries/abdomen.
Protein is also of utmost importance as it increases the amount of solutes in the blood, keeping the blood in its vessels (rather than contributing to swelling). So have small, protein-rich meals and protein powder on hand to make shakes. Dr. Aimee likes this brand.
Severe OHSS
Be in touch with your doctor right away if you show any of the symptoms mentioned above. And if you’ve been instructed to care for yourself at home with a mild case of OHSS, but you’re not feeling better, definitely let your care team know. You should also monitor your weight daily to make sure you’re losing the excess water weight.
Symptoms of more severe OHSS include:
Weight gain of 2 or more pounds in a single day or 10 pounds in 3 to 5 days
Worsening/severe abdominal pain
Difficulty urinating or decreased urine output
Continued or severe nausea, vomiting, and diarrhea
Trouble breathing
Abdominal distension or tightness
You should be seen immediately if you’re experiencing the severe symptoms above. While these are rare, we want you to avoid serious complications of OHSS such as blood clots, fluid entering the lungs, ovarian torsion or ovarian cyst rupture and more. If you go to the ER, be sure they’re in touch with your fertility doctor so that you’re not misdiagnosed.
If you do find yourself with mild OHSS symptoms after a retrieval, in addition to the at-home care your doctor recommends, acupuncture can be very helpful for bloating, pain and GI difficulties. If you’re at all concerned about OHSS, schedule an appointment with us in the few days following your retrieval as we’d love to support you!
Works Cited
Eyvazzadeh, A. How to Avoid the IVF Catastrophe of OHSS with Guest Dr. Nichole Barker. Dr. Aimee Eyvazzadeh. Retrieved October 10, 2021, from https://draimee.org/how-to-avoid-the-ivf-catastrophe-of-ohss-with-guest-dr-nichole-barker.
Eyvazzadeh, A. Your Complete IVF Checklist. Dr. Aimee Eyvazzadeh. Retrieved October 10, 2021, from https://draimee.org/your-complete-ivf-checklist.
Marcin, A. (2020, May 19). What Is OHSS and How Is It Treated? Healthline. Retrieved October 10, 2021, from https://www.healthline.com/health/infertility/ohss#symptoms.
Ovarian hyperstimulation syndrome (OHSS). ReproductiveFacts.org from the American Society for Reproductive Medicine. (n.d.). Retrieved October 10, 2021, from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-hyperstimulation-syndrome-ohss/.
The Management of Ovarian Hyperstimulation Syndrome. The Royal College of Obstetricians & Gynaecologists. (n.d.). Retrieved October 10, 2021, from https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_5_ohss.pdf.