Friday, May 10, 2013

How To Reduce The Risk Of OHSS


Question:
Hello,

I have been able to get pregnant naturally, but due to my kidney disease was not able to carry to term.  I have about 50 percent kidney function due to mild segmental mesangial sclerorsis.  I'm planning on pursuing surrogacy and would like to know what you would recommend for cycling treatment to reduce to the risk of OHSS (ovarian hyperstimulation syndrome) during the stimulation process?
Thank you, R. from California
Answer:

Hello R. from the U.S. (California),
First, I would choose a good IVF clinic.  OHSS is mostly due to overstimulation.  You'll want a doctor that is cautious, has a protocol to reduce the chances of developing OHSS and watches his patients carefully.

Second, OHSS tends to be most common in patients with PCOS where the ovaries are very sensitive to the stimulation.  If you don't have PCOS, then the chances of developing this problem are lower.

Third, patients at risk for OHSS get less medication than patients not at risk.  That is because their ovaries are so sensitive that they don't need much stimulation, and in fact, you don't want to stimulate them too strongly.  So a low dose FSH only or FSH/LH protocol is used.  I also don't use the "long protocol" in patients at risk for OHSS.  The long protocol is using Lupron injections starting from the luteal phase of the preceding cycle.  I use the antagonist protocol (the antagonist is to prevent spontaneous ovulation by suppressing the ovaries) which then allows me to trigger with Lupron instead of HCG (such as Ovidrel).

Finally, the estradiol levels and close monitoring of follicular growth are required so find a physician/clinic that works closely with their patients.  A large "factory" type of clinic is probably not a good choice. See this article regarding an American egg donor who underwent an IVF cycle through a Canadian clinic in 2011 to get an idea of the worst case scenario:  http://news.nationalpost.com/2013/03/28/kylee-gilman-sues-toronto-fertility-doctor/

Good Luck!

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility And Gynecology Center
Monterey Bay IVF
www.montereybayivf.com

Monterey, California, U.S.A.

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