OHSS during IVF – 7 ways to reduce the risk
OHSS, or ovarian hyperstimulation syndrome, is a potentially serious side effect of IVF. Or, more accurately, of the gonadotrophin medication used in IVF treatment using your own eggs. One in eight IVF cycles leads to OHSS, with varying degrees of seriousness. If you’ve got PCOS, you need to take particular care. The good news? The risks of getting OHSS can be reduced by competent clinics – and you. Here are 7 tips.
1. Don’t skimp on pre-treatment tests.
OHSS can be managed better if you do the right tests. So make sure you have a transvaginal scan just before treatment. Your clinic can then have a good look at your ovaries and any cyst formations. And have an up-to-date blood hormone profile, to include FSH and LH. These scores give the clinic information about PCOS, the common precursor to OHSS. Help your doctor identity the risk. Don’t rely on tests and scans you did a year ago.
2. Scan once, twice or more.
When you’re on your stimulating medication, regular ultrasound scans and blood tests should be done. You need to check your follicles aren’t going haywire. A first scan on day 6 or 7 is the norm. Then one every two days if things are looking iffy.
3. Get the meds right.
Higher-than-necessary doses of medication are an open invitation to OHSS. They’re also negligence. Your clinic should put you on the lowest dose of gonatrophins possible. Your meds can always be adjusted. Even if your IVF cycle understimulates your ovaries initially, that’s preferable to getting OHSS. Better to play it safe.
4. Coast it.
Another way to reduce the risk of OHSS is to delay egg retrieval. Once again, this is down to the skill and care of your clinic. If you’re developing too many follicles or there’s too much estrogen flying around, it may be best to stop your meds and delay your trigger shot for a few days. Blood tests are key. You want to get those estrogen levels down. This technique is called coasting.
5. Get trigger-happy.
PCOS patients, and others prone to OHSS, can be prescribed an alternative trigger shot. OHSS only happens after your trigger shot – and the HCG is partly to blame. On-the-ball clinics recommend a different approach. Low-dose Decapeptyl (0.1 mg) can be used in some protocols. (Oddly, this is hard to get in the UK.) The natural hormone kisspeptin may also help.
6. If in doubt, delay.
Postponing your transfer is a prudent, and fairly standard, way to defeat OHSS. That means collecting your eggs, freezing them, and giving your ovaries a rest for a few months. You can then have a frozen embryo transfer (FET). Lower chance of success; lower chance of OHSS. It’s better than cancelling the treatment altogether.
7. In the pipeline…
Doctors are continually looking at additional approaches to minimising the OHSS risk. These include follicle aspiration, the use of dopamine, and intravenous albumin on egg-retrieval day. Metfomin, a common PCOS drug, can also reduce the incidence of OHSS. Read more about PCOS here.
A final thought on OHSS and IVF. About 1 in 25 patients get the severe form of OHSS. When choosing your clinic, ask them about their OHSS management. If you don’t feel reassured, go elsewhere. Your life could depend on it.