10 Feb OHSS during IVF – 7 ways to reduce the risk
OHSS, or ovarian hyperstimulation syndrome, is a potentially serious side effect of IVF. 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 OHSS can be reduced by competent clinics – and you. Read our seven key tips.
1. Don’t skimp on pre-treatment tests.
OHSS can be managed better if you have the right pre-treatment assessment. A transvaginal scan before treatment is a must. Your clinic can then see first-hand if you’re multi-follicular (an OHSS warning sign). A blood hormone profile, to include FSH and LH, is also essential. The ratio between those scores can flag up PCOS. As can an unusually high AMH score. Don’t rely on tests you did a year ago. Do new ones.
2. Scan once, twice or more.
When you’re on your stimulating medication, have regular scans. You need to check your follicles aren’t going haywire. A first scan on day seven or eight is the norm. Then one every two days if things are looking iffy. 15 or more follicles on egg retrieval day are an OHSS warning.
3. Get the meds right.
Higher-than-necessary doses of medication are an open invitation to OHSS. Your clinic should put you on the lowest dose of gonatrophins possible. That’s typically 125 or 150 units daily. Minimal stimulation is another way to reduce the chance of OHSS.
4. Coast it.
Another way to mitigate the risk of OHSS is to delay egg retrieval. If you’re developing too many follicles, it may be best to stop your meds and delay your trigger shot for a few days. This technique is called coasting. More often, PCOS patients find their follicles grow well initially but struggle to reach their optimal size towards the end of stimulation. So egg retrieval is put back anyway.
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) or Buserelin (5.5 mg) can be used instead.
6. If in doubt, delay.
Postponing your transfer is a prudent, and fairly standard, way to defeat OHSS. That means collecting your eggs, fertilising them and freezing your embryos. You can then return for a frozen embryo transfer six to eight weeks later. FETs are as successful as fresh transfers these days. The inconvenience of postponement may work in your favour.
7. In the pipeline…
Doctors are always looking at ways to minimise the OHSS risk. These include follicle aspiration, the use of dopamine, kisspeptin, and intravenous albumin on egg-retrieval day. Metfomin, a common PCOS drug, can also help. Read more about PCOS here.
A final thought on OHSS and IVF. About 1 in 100 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. The condition must be taken seriously. And it usually is.