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Causes
By Mayo Clinic staffOvarian hyperstimulation syndrome develops after you take a type of fertility medication that acts directly on your ovaries, stimulating them to produce multiple eggs. This treatment is more likely to cause symptoms of ovarian hyperstimulation than is the more common approach to inducing ovulation — treatment with clomiphene (Clomid, Serophene), a medication that's given as a pill you take by mouth. Your doctor might prescribe oral medication at first before moving on to injectible medications because oral medications are easier to take and they're less expensive.
The hormonal drugs most likely to be involved with developing OHSS are:
- Follicle-stimulating hormone (FSH), which stimulates the formation of multiple fluid-filled cysts (follicles) on the ovaries
- Luteinizing hormone (LH), which supports egg maturation and triggers ovulation
- Human menopausal gonadotropin (hMG), which has both LH and FSH
- Human chorionic gonadotropin (HCG), a stand-in for the LH surge that, in natural cycles, causes the follicle to release the egg
OHSS usually happens after the follicle-stimulating phase of a fertility therapy, when you receive an injection of HCG to trigger ovulation. Typically, signs and symptoms appear within the first 10 days after the injection, when the ovarian blood vessels have an abnormal reaction to the hormone and begin to leak fluid. This fluid can swell the ovaries and sometimes moves into the abdomen in large amounts.
Some women may even develop OHSS during a pregnancy achieved following ovulation induction, as pregnancy itself causes a natural increase in HCG levels.
- Van Voorhis BJ. Outcomes from assisted reproductive technology. Obstetrics & Gynecology. 2006;107:183.
- Manno M, et al. Ovarian hyperstimulation syndrome: The best approaches for prevention and treatment: A mini-review. Current Women's Health Reviews. 2007;3:49.
- Lobo RA. Infertility: Etiology, diagnostic evaluation, management, prognosis. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed Dec. 2, 2010.
- Practice Committee of the American Society for Reproductive Medicine. Ovarian hyperstimulation syndrome. Fertility and Sterility. 2006;86(suppl):S178.
- Insler V, et al. Pathogenesis of ovarian hyperstimulation syndrome. http://www.uptodate.com/home/index.html. Accessed Nov. 23, 2010.
- Insler V, et al. Classification and treatment of ovarian hyperstimulation syndrome. http://www.uptodate.com/home/index.html. Accessed Nov. 23, 2010.
- Luke B, et al. Factors associated with ovarian hyperstimulation syndrome (OHSS) and its effect on assisted reproductive technology (ART) treatment and outcome. Fertility and Sterility. 2010;94:1399.
- Doody KJ. Treatment of the infertile couple. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aid=3158038. Accessed Dec. 6, 2010.
- Humaidan P, et al. Preventing ovarian hyperstimulation syndrome: Guidance for the clinician. Fertility and Sterility. 2010;94:389.
- Insler V, et al. Prevention of ovarian hyperstimulation syndrome. http://www.uptodate.com/home/index.html. Accessed Nov. 23, 2010.
- Coddington CC (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 22, 2010.
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