Treatment Of Ovarian Hyperstimulation Syndrome
If after receiving a hormone injection you develop any of the symptoms described above, you should notify our center immediately.
Careful monitoring, decreased stimulation medication, taking pain medicine and drinking lots of fluids are recommended. There is also some increased risk of developing a blood clot if you have OHSS, so your doctor may recommend taking a baby aspirin.
Although very uncommon, severe OHSS symptoms can be treated through hospitalization for intravenous fluid hydration or, in rare circumstances, inserting a needle in the abdomen to remove excess fluid.
Since symptoms are usually resolved within two weeks, if you do not achieve pregnancy through fertility treatment, the doctor may advise that all embryos be frozen so they can be transferred after recovery.
If severe OHSS occurs after conceiving, it can last up to the tenth week of pregnancy and then resolve.
What Other Complications Occur With Severe Ohss
Complications from OHSS can be severe. You may become dehydrated and pressure in your abdomen may increase from too much fluid. These problems can lead to blood clots forming within the blood vessels. Blood clots can travel to your lungs or to other important organs. This can be potentially life-threatening.
These complications can usually be avoided by recognizing the signs, symptoms, and laboratory evidence that OHSS is getting worse and getting appropriate treatment.
Preparing For The Procedure:
Most of the dos and donts that will help improve the number and quality of eggs retrieved need to happen 30-90+ days prior to your retrieval. So, while the night before is certainly important, its really what you do three months prior that has the most impact on your success. A healthy body is a fertile body: acupuncture, a high-fat fertility diet, and vitamins are important.;
The day of, relax, stay positive, and give yourself enough time to get to your doctors office ahead of time without needing to rush.
That said, the egg retrieval is a surgery and its important you follow the instructions given by your healthcare team carefully. Its likely you will be asked to follow a number of instructions or precautions in preparation for your egg retrieval procedure.
Some common to dos include:
- to wear comfortable, easy to remove clothing
- arrive early, usually an hour before the intended retrieval
- make sure you have a ride home its usually recommended that family or a close friend accompany you to your egg retrieval, but other ride arrangements may be made. You will not be allowed to drive home yourself.
Some important do nots include:
- to not eat or drink anything after midnight on the day of your procedure.
- ;to not wear perfumes or fragrances other than deodorant the day of the egg retrieval procedure.
The nurse will then hook you up to several monitors so that your vital signs can be closely monitored before, during and after the procedure.
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What To Expect At Your Ivf Egg Retrieval
You will be asked to check in to our Norwalk office approximately one hour before your scheduled procedure time. Once youve been greeted by our front desk staff, you will be taken back to our operating room, shown your private prep and recovery area , and given a gown and cozy socks to change into .
You will then meet with our OR nurses who will go over paperwork and start your IV. Youll also meet the anesthesiologist and the reproductive endocrinologist who will be performing your procedure that day.;
Ever wonder what the difference between a Reproductive Endocrinologist and Fertility Specialist is?
Please note, our doctors rotate through the operating room covering all seven days of the week. Therefore, you may or may not see your primary doctor on egg retrieval day. If your egg retrieval doesnt happen with your primary doctor, dont worry! He or she will be monitoring your progress remotely and getting updates throughout the day.
The egg retrieval is an extremely safe and relatively simple procedure that averages 15 minutes from start to finish. Our anesthesiologist will administer medications through your IV so that you are comfortably asleep the whole time. Once asleep, the fertility doctor will place an ultrasound probe vaginally and look at your follicles on the monitor. This step is identical to what you experienced during those early morning monitoring appointments.;
Victoria Hopes To Raise Awareness About Infertility
“I have been diagnosed with ‘Unexplained Infertility”‘because every single one of my tests and lab results all come back ‘perfect,'” Victoria said. “They can’t figure out why I haven’t been able to conceive on my own.
“I hope no women has to endure fertility struggles, but if she does, I want her to know she’s not alone and it’s way more common than we think.”
Victoria is also hoping to raise awareness about “what women going through IVF do have to endure.”
“Since unfortunately infertility rates are on the rise, many people know someone going through infertility. I hope to shed light on what that friend or family member will endure so they can be more empathetic to their experience.
“I’ve received countless comments and messages from people who aren’t going through infertility themselves, but my story is allowing them to understand what their loved one is going through.”
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How Egg Retrieval Works
Egg retrieval involves a surgical procedure with a mild sedative given through an IV. The woman will breathe on her own throughout the surgery, but she wont remember or feel anything, explains Dr. Roth.;
After shes sedated, the womans legs are placed in a stirrup and surgeons conduct a vaginal ultrasound. Theyll insert a needle through the vaginal wall into the ovary. The needles go into each ovarian follicle and use gentle suction to pull out the fluid and the egg that comes with it, says Dr. Roth. Doctors give this fluid to the embryologist, who can immediately tell how many eggs they’re getting. ;
The woman wakes up about 30 minutes later, recovers for one-two hours at the healthcare center, then heads home to rest. Since driving isnt advised for 24 hours, a friend or family member usually escorts her home. Dr. Roth says most patients can return to work the next day, although they may experience minor side effects. There are no scars or stitches required for the surgery.
The Third Level: Ovarian Hyperstimulation Syndrome
Imagine NOW, that instead of 12 employees being hired and squeezing into one office, that all 45 are hired! We can squeeze all 45 in the door, but they are scrunched tight, uncomfortable, literally pouring out into the hallway. This is what happens during OHSS.
While approximately 15% of IVF patients experience mild hyperstimulation symptoms, such as bloating and menstrual like cramping, most will never suffer from moderate or severe OHSS.
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Were The Fertility Injections Painful
Injecting myself with hormones didnt feel great, but honestly, stubbing your toe is worse, says Claire. I definitely experienced mood swings and bloating but nothing too much worse than having PMS.
Hillie said giving yourself shots is a daunting process, but not painful. “The needles aren’t particularly big, and you’re injecting;into your stomach for the most part,” she says. “Its a little surreal and a little weird to be giving yourself so many shots so often, but it didn’t actually hurt.
How Do The Doctors Determine Which Trigger Shot I Should Have
There are two main types of trigger injection:
- The hCG trigger injection, which is usually used by people whove been on the long protocol. Brand names include Ovitrelle, Pregnyl and Choragon.
- The GnRH agonist injection, which is usually used by people whove been on the short protocol. Brand names include Lupron and Synarel.
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What Does Ivf Egg Collection Feel Like Is It Painful
I visited an IVF forum and asked fellow members a bunch of questions about their own egg-collection experiences. Below is what they said about the pain associated with the procedure itself, grouped according to the type of;sedation/pain relief they had. You might want to be aware that NICE recommends conscious sedation for the procedure , but very;few people seem to have chosen or been given that option.
People who had a general anaesthetic had this to say about the procedure:
- It felt like I just had an amazing sleep.
- Was asleep so cant really comment on the procedure itself.
Those who had heavy sedation:
Those who had conscious sedation:
- Egg collection wasnt nice. I was awake the whole time. I had a drip in my arm where the pain relief was administered. I had to ask for more. I was so glad when it was all over.
- I was given wakened sedation, but was completely out for the whole procedure. It was absolutely;fine.
Those who had a local anaesthetic with gas and air:
- There was an initial sting with the local anaesthetic, but after that it was fine easier than expected. The only thing I hated was hearing them count the eggs after they came out. I was fixated on it after the disappointment of the first round, and this stressed me out more than anything else. I also wasnt too chuffed with the doctor/nurses having a chat right in front of my stirruped legs without any dignity sheet in place!
What Is Ovarian Hyperstimulation Syndrome
Ovarian hyperstimulation syndrome can occur when the ovaries are over stimulated by fertility medications and hormones. Too many stimulant hormones in a womans system can lead to OHSS, characterized by swollen, painful ovaries.
OHSS may occur from the injectable hormone medications used during in vitro fertilization . Fertility medications used in IVF stimulate a womans ovaries to produce more oocytes than during normal ovulation . How much medication is needed to achieve the correct stimulation requires careful monitoring and is not an exact process.
Less often, OHSS can occur from milder fertility medications taken by mouth, such as clomiphene, or occurs spontaneously.
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How Do You Like Your Eggs Tips For Egg Retrieval And Egg Transfer
There are thousands of ER and ET tips and testimonials online I spent hours reading them and then decided to take some advice from;some fertility bloggers;as well as advice from my doctors that had worked for me. I compiled this list of my favorite tips below.
TIPS: HOW I PREPARED FOR EGG;RETRIEVAL;
TIPS: MY POST EGG RETRIEVAL EXPERIENCE;
- Drank Gatorade and protein drinks. Peeing was painful and uncomfortable but I didnt let up on the liquids to avoid dehydration.
- Was instructed by doctors to avoid all starchy carbs such as white bread, pasta, and rice;until I was told to ease my way back in after the 2WW. This can disturb the insulin levels and can cause OHSS . My reasoning was also to stop the bloating since I had so much of it.
- Cut down on sugars for this same reason.
- Tried not to freak out that I looked an felt 4 months pregnant, since I was that bloated.;My clothes were a problem. Maxi dresses were my saving grace.
- Had zero sexy time with my husband. Sucks, it will be a while before I do the nasty again .;The cherry on the top is that you cant even give personal stimulation because it will disrupt your insides too much.
TIPS: MY POST EMBRYO TRANSFER EXPERIENCE
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How Did You Prepare For Egg Retrieval
Claire Wasserman, founder and director of programming at;Ladies Get Paid, retrieved her eggs through Extend Fertility. She first attended a workshop about the process, which included training on how to inject her two fertility medications. Then she visited the clinic one day after her period began to get blood work and an ultrasound. She returned for five additional visits, during which doctors measured her follicles and conducted blood work to check estrogen levels. Halfway through, they gave me a third medication, called an antagonist, which prevented any one particular follicle from dominating, as well as stopping any ovulation, she says. When they decided my follicles were large enough, they added a fourth medication called the trigger shot, which kickstarted the maturity process and gave us a 36-hour window before retrieval.
Every woman has her own way of preparing for the procedure mentally and physically.;Take;Hillie, a Chicago-based woman in her mid-30s who retrieved and froze her eggs.;For me, it was about consistency for my mental and physical space. I talked to a therapist ;someone outside the realm of my friends, who didn’t fully understand what I was going through, she says.;
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Will It Hurt What Kind Of Anesthesia Will I Get
This is probably the most common question we hear as fertility doctors. Patients worry about any kind of procedure, with due reason! What I tell patients is that, on the scale of surgeries, this is a very minor one, with less than a 1% risk of complication. A small intravenous catheter will be put in your arm or hand upon your arrival in the office on the day of your egg retrieval, and then you will be given medications through the IV to go to sleep. Most patients sleep through it, but some are semi-awake and pain-free. This isnt a general anesthesia, so you will still be breathing on your own. Sometimes a breathing mask is used to give you extra oxygen, and you might hear the OR staff ask you to take deep breaths on occasion. No incisions are made; everything is done through the vagina.
Initially, a speculum is placed in the vagina so that the area can be cleaned, which you might feel mildly. You will feel some pressure from the ultrasound during extraction of the eggs, but not pain. Some patients are semi-awake but feel no pain and even talk with the nurse during the procedure! The anesthesia meds are short-acting; they last for the entire procedure, which is approximately 30 minutes, and they wear off within an hour, but we do tell patients to take the day off and not to drive or do strenuous activity that day. Most likely, you will go home and sleep the rest of the day.
What Happens To The Eggs After Theyve Been Collected
A few hours after egg retrieval , theyll be mixed with the sperm. If youre having ICSI, a single sperm will be injected into each mature egg.
The day after the eggs and sperm have been mixed, theyll be checked to see how many have fertilised . At this stage theyre called embryos, and theyll be monitored constantly to see how they develop.
The embryos will spend up to six days inside their own personal incubators, and youll be phoned each day with an update on both their progress and when the most suitable day for transfer might be . Some embryos will be better quality than others, and itll be one of the good uns that;they transfer back into you.
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What Happens Next After The Retrieval
Once the eggs are removed and the procedure is complete, you will rest in the recovery room for about an hour, to make sure the anesthesia medication wears off and you can stand up, walk and use the washroom. Mild nausea is common, and often you will get medication in the IV to prevent this.
Typically, you will go home and sleep most of the rest of the day, and you should be fine by the next day to resume normal activities.
The eggs go to the laboratory to be prepared for freezing or for fertilization with sperm to create embryos. Dont worry: They are safe and sound!
Depending on the number of eggs retrieved and the plan after retrieval, you could possibly be asked to return to the clinic for an evaluation the next day or to come in for a fresh transfer in the next few days. If your embryos are being frozen, then you would come back in the next cycle to start a frozen embryo transfer.
How To Prevent Ovarian Hyperstimulation Syndrome
OHSS is often managed with decreased activity, drinking electrolyte-rich fluids, draining fluid that accumulates in the abdomen, medication for nausea and pain, and careful monitoring of the ovaries by ultrasound.
Because pregnancy can make OHSS worse or last longer, those who are at risk or are experiencing the symptoms will have all eggs and/or embryos frozen for transfer at a later time.
This allows for the OHSS to resolve more quickly and can prevent the worsening of the symptoms later on.
It is important that patients recognize the signs of OHSS and are aware of body changes throughout their IVF cycle.
It is imperative that all patients contact their physician or nurse if any of these signs or symptoms occur, so proper care and preventative methods can be taken.
Jacqueline N. Gutmann
Dr. Jacqueline N. Gutmann is board certified in OB/GYN and sub-specialty board certified in Reproductive Endocrinology and Infertility at RMA Philadelphia. She currently serves on the medical advisory board of the American Fertility Association . She has been featured on The Learning Channel and in Philadelphia Magazine. Dr. Gutmann is also a Clinical Associate Professor of Obstetrics and Gynecology at Thomas Jefferson University. She has also been named a Top Doc by Philadelphia Magazine and physician rating companies Castle Connolly and Vitals.com.
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