Ovarian Hyperstimulation Syndrome (OHSS): Risks, Symptoms & Prevention

Ovarian Hyperstimulation Syndrome (OHSS) affects 0.2-1.0% of patients undergoing gonadotropin-induced ovarian stimulation, with severe cases occurring in 0.5-2.0% of IVF cycles. Key risk factors include young age, low body weight, PCOS, and previous OHSS history. Prevention through careful monitoring of follicle count and gonadotropin dosing remains critical to reducing complications.

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Key Takeaways

OHSS Risk Factors: Young Age, PCOS & Previous History

Patients under 35, those with PCOS, and individuals with a prior OHSS diagnosis are at highest risk. Follicle count also correlates with severity—cycles producing more than 20 follicles significantly increase OHSS likelihood.

Preventing OHSS: Monitoring & Gonadotropin Adjustments

Serial ultrasounds and estrogen level checks are essential to track follicle development. Reducing gonadotropin dose or canceling high-risk cycles can prevent OHSS progression in patients with 15+ follicles.

OHSS Management: Outpatient vs. Hospital Care

Mild cases require outpatient management with daily weight tracking, electrolyte intake, and activity restriction. Severe OHSS demands hospitalization for IV hydration, pain control, and monitoring for complications like thromboembolism.

Recognizing OHSS Symptoms & Severity Classification

Mild symptoms include abdominal bloating and nausea. Severe OHSS involves ascites, oliguria, and respiratory distress. Delayed onset (after egg retrieval) and pregnancy (which worsens symptoms) are critical clinical markers.

OHSS and Pregnancy: Increased Risk and Duration

Pregnancy following IVF doubles OHSS severity and prolongs symptoms due to elevated hCG levels. Early pregnancy termination may be recommended in high-risk cases to mitigate complications.

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