Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome diagnosis may be based on:

• A physical exam. Your provider will look for any weight gain, increases in your waist size and abdominal pain you may have.
• An ultrasound. If you have ovarian hyperstimulation syndrome (OHSS), an ultrasound may show that your ovaries are bigger than usual, with large fluid-filled cysts where follicles developed. During treatment with fertility drugs, your provider regularly evaluates your ovaries with a vaginal ultrasound.
• A blood test. Certain blood tests allow your provider to check for abnormalities in your blood and whether your kidney function is being impaired because of OHSS.

Ovarian hyperstimulation syndrome generally resolves on its own within a week or two or somewhat longer if you're pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications.

Mild to moderate OHSS

Mild OHSS typically resolves on its own. Treatment for moderate OHSS may involve:

• Increased fluid intake
• Frequent physical exams and ultrasounds
• Daily weigh-ins and waist measurements to check for drastic changes
• Measurements of how much urine you produce each day
• Blood tests to monitor for dehydration, electrolyte imbalance and other problems
• Drainage of excess abdominal fluid using a needle inserted in your abdominal cavity
• Medications to prevent blood clots (anticoagulants)

Severe OHSS

With severe OHSS, you may need to be admitted to the hospital for monitoring and aggressive treatment, including IV fluids. Your provider may give you a medication called cabergoline to lessen your symptoms. Sometimes, your provider may also give you other medications, such as gonadotropin-releasing hormone (Gn-RH) antagonist or letrozole (Femara) — to help suppress ovarian activity.

Serious complications may require additional treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.

If you develop mild ovarian hyperstimulation syndrome, you'll probably be able to continue your day-to-day routine. Follow your provider's advice, which may include these recommendations:

• Try an over-the-counter painkiller such as acetaminophen (Tylenol, others) for abdominal discomfort, but avoid ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) if you have recently had an embryo transfer, as these drugs can interfere with implantation of the embryo.
• Avoid sex, as it may be painful and can cause a cyst in your ovary to rupture.
• Maintain a light physical activity level, avoiding strenuous or high-impact activities.
• Weigh yourself on the same scale and measure around your abdomen each day, reporting unusual increases to your provider.
• Call your provider if your signs and symptoms get worse.

Depending on how severe your ovarian hyperstimulation syndrome is, your first appointment may be with your primary care provider, your gynecologist or infertility specialist, or possibly with a treating doctor in the emergency room.

If you have time, it's a good idea to prepare in advance of your appointment.

What you can do

• Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• Make a list of any medications and vitamin supplements you take. Write down doses and how often you take them.
• Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
• Take a notebook or notepad with you. Use it to write down important information during your visit.
• Prepare a list of questions to ask your provider. List your most important questions first.

Some basic questions to ask include:

• What's the most likely cause of my symptoms?
• What kind of tests do I need?
• Does ovarian hyperstimulation syndrome usually go away on its own, or will I need treatment?
• Do you have any printed material or brochures I can take home with me? What websites do you recommend?

Make sure that you completely understand everything that your provider tells you. Don't hesitate to ask your provider to repeat information or to ask follow-up questions for clarification.

What to expect from your provider

Some potential questions your provider might ask include:

• When did your symptoms begin?
• How severe are your symptoms?
• Does anything make your symptoms better?
• Does anything seem to make your symptoms worse?