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Prevention
By Mayo Clinic staffTo lessen the chance that you'll develop ovarian hyperstimulation syndrome, your doctor will create an individualized plan for your fertility medications, taking into account any risk factors you have for OHSS. Your doctor will also carefully monitor each treatment cycle with frequent or daily ultrasound exams to view the development of follicles, and with blood tests to check your estradiol level.
Your doctor may use a variety of strategies to help prevent ovarian hyperstimulation syndrome:
- Adjusting medication dosage. Your doctor will use the lowest possible dose of gonadotropins to achieve the goals of stimulating your ovaries and triggering ovulation.
- Coasting. If your estradiol levels are high or a large number of follicles have developed, your doctor may stop your gonadotropin injections and wait a few days before giving HCG, which triggers ovulation. This is known as "coasting."
- Avoiding use of HCG. Because OHSS develops only after HCG is given, alternatives to HCG for triggering ovulation are being studied as a way to prevent OHSS.
- Follicle aspiration and freezing all embryos. For women undergoing IVF, all the follicles (mature and immature) may be removed (aspirated) to reduce the chance of OHSS. The mature follicles are fertilized and frozen, and the ovaries are allowed to rest for one or two cycles. Then the desired number of embryos are thawed and transferred back to your uterus. This procedure slightly reduces the chance of pregnancy and costs more, but it almost eliminates the chance of OHSS.
References
- 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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