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Friday, April 26, 2013

Ovarian Hyperstimulation Syndrome

Many women going through fertility hear about Ovarian Hyperstimulation.  However, it doesn't happen to most women.  I have had this issue not once but twice.  I am not only going to share the basics they tell you, but also how it really affects a person.

Ovarian Hyperstimulation Syndrome: According to Medlineplus and personal experience this is a syndrome that occurs when taking fertility medication.  To many eggs are produced and the ovaries start overproducing hormones.  This is exacerbated by HcG produced by a successful pregnancy. 

The symptoms of OHSS can range from mild to severe. Most women with the condition have mild symptoms such as:
  • Abdominal bloating
  • Mild pain in the abdomen
  • Weight gain
In rare cases, women can have more serious symptoms, including:
  • Significant weight gain (more than 10 pounds in 3 - 5 days)
  • Severe pain or swelling in the belly area
  • Decreased urination
The reason this occurs is that you end up with a large imbalance of hormones.  This literally causes your capillaries to leak fluid.  This can get worse if you get pregnant.  If pregnancy occurs it keeps pumping hormones and HCG into the blood stream which exasperates the symptoms.  There is a large likelihood that this pregnancy will terminate due to the stress put on the body, keep positive if you can but that is something the doctors will not tell you.  You should be aware that miscarriage is a very real possibility.  Fluid may have to be drained from the abdominal cavity if it has pooled in sufficient quantities.  Once you have had OHSS you are more likely to have the issue again.

Draining is done by insuring a needle into the vaginal wall to get to the uterine area and drain off a maximum of 1000cc's (a large IV bag).  A larger drain can cause shock to the system.  This procedure is preformed without anesthesia.
The first time I had OHSS I gained more than 30 lbs in one week.  This was pooled not only in my abdominal cavity but also distributed throughout my body.  I looked like I went from normal to morbidly obese in seven days.  I was so excited about my pregnancy that I didn't care, in fact when I asked I was told that this could be normal.  NEVER assume that type of weight gain is normal.  You should only gain about five pounds in the first few weeks of pregnancy.  Anything over that might show an issue.  I was so swollen that I had trouble sleeping.   Anytime I was on my side it hurt, not small amounts of hurt, I was in serious pain.  I finally ended up in the ER more than a week after I should have.  I was five weeks pregnant at this time.  I would have been admitted and should have been.  However, no one at that hospital knew how to properly perform the draining procedure.  When I went to the ER I couldn't move.  When they did the ultrasound to see how the pregnancy was progressing as well as the location of fluid pockets I wanted to scream.  I was finally allowed pain killers and slept well for the first time in a week.  I went in about 8:00am on a Sunday and I didn't leave until after 9pm that day.  Not only that, but I had no wait, this was all procedures including getting massive doses of diuretics.  My procedure to be drained was scheduled for 6 am Monday with my fertility doctor.

 I also remember that they did a quick check to see how the pregnancy was progressing.  I knew something was wrong when they stopped referring to "my baby" and started talking about my pregnancy.  I always thought it was too early to tell anything.  I guess there was more than one dimple in my uterus lining.  I did find out later that twins were suspected.  This was later confirmed during the miscarriage.  That is one of the reasons the OHSS was so severe for me.  After the draining procedure I had to get my liver and organ function panels every week for a month.  This was to ensure that no lasting damage had been done to my organs.  If you are having any of the above mentioned symptoms talk to someone.  Never assume that it is normal and that you are being a crybaby.  Had I gone in sooner I might have been able to save my pregnancy.  As it was I overstressed my body and nearly killed myself as well as ended my pregnancy. 
If you start having these types of symptoms you need to start drinking a lot of fluids.  I know that seems counter intuitive since you are leaking fluid.  However, any form of dehydration can make this issue worse.  On top of increasing your fluid intake you need to lower your sodium and get a lot of rest.  This will help to mitigate the overall symptoms.  Almost nothing can be done to stop this from occurring, but you can you try to make sure that you don’t end up as sick.  

The second time I had OHSS, pregnancy did not occur and I knew what I was looking for.  I was able to put a stop to the symptoms just as they started.  

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