Ovarian Hyperstimulation Syndrome

Patient Information
Womens Health Service, Wellington Hospital

What is Ovarian Hyperstimulation

Syndrome?
As part of their fertility treatment many women
take medication by tablets or injections to
stimulate their ovaries to produce many egg sacs
(follicles). Sometimes there is an excessive
response to fertility drugs and this causes
Ovarian Hyperstimulation Syndrome (OHSS).
Overstimulated ovaries enlarge and release
chemicals into the bloodstream that make the
blood vessels leak fluid into the body. Fluid leaks
into your abdomen, and in severe cases, into the
space around the heart and lungs. OHSS can
affect the kidneys, liver and lungs. A serious but
rare complication is a blood clot (thrombosis).

have had OHSS previously

get pregnant, particularly if it is a multiple
pregnancy (twins or more)

How long does OHSS last?

Most of the symptoms should resolve in a few
days. If you have mild OHSS you can be looked
after at home.
If your fertility treatment does not result in a
pregnancy, OHSS will get better by the time your
period comes.
If your fertility treatment results in a pregnancy,
OHSS can last up to a few weeks or longer.

What should I do if I have mild OHSS?

What are the symptoms of OHSS?
The symptoms include abdominal swelling or
bloating due to the enlarged ovaries, nausea and
as the condition get worse, vomiting.
Mild OHSS - mild abdominal swelling or bloating,
abdominal discomfort and nausea.
Moderate OHSS symptoms of mild OHSS but
the swelling and bloating is worse because fluid
is building up in the abdomen. There is
abdominal pain and vomiting.
Severe OHSS Symptoms of moderate OHSS
plus extreme thirst and dehydration because so
much fluid is building up in the abdomen, passing
very small amounts of concentrated urine,
difficulty breathing because of the build up of
fluid in the chest and a red, hot, swollen and
tender leg due to a clot in the leg or lungs
(thrombosis).

Who gets OHSS?

Mild symptoms are common in women having
IVF treatment. As many as one in three (33%)
women develop mild OHSS. About one in 20
(5%) women develop moderate or severe OHSS.
The risk of OHSS is increased in women
who:
have polycystic ovaries

Make sure you drink clear fluids at regular

intervals. Make sure you do not drink in excess. If
you have pain, take paracetamol or codeine (no
more than the maximum dose).
Even if you are tired, make sure you continue to
move your legs to prevent blood clots.

When should I call for medical help?

Call for medical help if you develop any of the
symptoms of severe OHSS, particularly if you are
in pain despite taking pain relief.
If you start to vomit, have urinary problems, chest
pain or any difficulty breathing.

When will I need to stay in hospital?

There is no specific test that can diagnose OHSS.
A diagnosis is made on the basis of your
symptoms. Your doctor will ask you to describe
your symptoms and will examine you. In addition
your doctor may order:

Blood tests to check your Kidney, Liver

and clotting functions
You will be weighed and your abdomen
measured. This is to confirm if fluid is
building up or reducing.
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Fluid intake and output (how much you

drink and how much urine you pass) will
be monitored.
Ultrasound scan of your ovaries to
measure how big they are and whether
there is any fluid build-up in your
abdomen.

The management of your care will depend on the

severity of the symptoms.

What is the treatment for OHSS?

There is no treatment that can reverse OHSS.
OHSS will get better with time, so treatment is to
help symptoms and prevent problems. This
includes:
Medication to control nausea and
vomiting. This can be given either as a
tablet to take by mouth or by an injection
into an IV line in your arm/hand.
Analgesia can be given for discomfort or
pain caused by the symptoms of OHSS.
Anti-inflammatory pain relief such as
voltaren should be avoided as it can
cause bleeding. Medication that is given in
the hospital will be safe for your unborn
child should you have an early pregnancy.
You will be given a pair of anti-thromboembolism stockings (called TED
stockings) to help prevent blood clots
developing in your legs or lungs. This is
because the disturbance in liver function
can affect your blood clotting mechanism
putting you at a higher risk of developing
blood clots. You may also be given an
anti-clotting injection into the skin of your
abdomen once a day to reduce the risk of
clotting.
You will be asked to exercise by walking
in the ward as well as moving your legs
and feet in bed. This will help blood
circulation.
An intravenous(IV) line is inserted into a
vein in your arm or hand to give fluid to
help keep you hydrated. The fluid shift
caused by OHSS means that although
you have excess fuid in your abdomen,
this fluid has shifted from your circulation.
As a result, the fluid in your circulation will
decrease causing dehydration and making
you thirsty.
There may be a restriction placed on your
overall fluid intake. This would allow you
GA PIB-37 Issued April 2013 Review April 2016

no more than 2-3 litres of total fluid intake

over a 24 hour period.
If you have difficulty in passing urine, or if
you are passing significantly reduced
amount of urine, a catheter may need to
be placed in your bladder. This will enable
the staff to accurately record the amount of
urine you are passing.
In rare cases where there is a large
amount of fluid in the abdomen causing
significant discomfort, a procedure called
paracentesis may be offered.This involves
a cannula (a thin tube) being inserted into
the abdominal wall to drain off the excess
fluid.

A paracetesis will only be considered in severe

OHSS because it cannot stop the fluid being
collected in the abdominal wall. As with any other
procedure there are risks involved. Should a
paracentesis be recommended the dictor will
discuss the procedure with you first.
Paracenthesis will only provide temporary relief
and fluid may accumalate again causing furter
discomfort.

Is my baby at risk if I have OHSS?

There is no evidence of problems in the baby as a
result of having OHSS.

Leaving Hospital
You will be discharged from hospital once your
condition has improved and you are well enough
to go home.

Contact details
Womens Clinics-Acute Assessment
Level 3 North
Wellington Hospital
Phone 04 8060 740
Ward 4 North (Pod A Gynaecology)
Level 4,
Wellington Hospital
Phone 04 8060 881 (Extension 80881)

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