Friday, May 10, 2013

How To Reduce The Risk Of OHSS


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

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:

Good Luck!

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

Monterey, California, U.S.A.

1 comment:

  1. Hello doctor,
    I have panhypopitutrism. Now taking thyroxine , oral estrogen , hydrocortisone and growth hormones as a replacement.
    I also have pcos and my BMI is 28.
    I have OHSS. Tried ovulation induction with protocol of FSH+LH and resulted into severe OHSS after hcg shot of 10000 IU.
    With 40 to 50 follicles ( max 18 , 16 , 16, 21 , 15mm ) rest were bewteen 8mm to 13mm. Doctor recommended me IUI but i did time intercourse. Anyways , none of the cycle was successful.
    Now , my question is , is there any protocol to prevent OHSS. Bcz naturally i have 0 hormones. My ovaries never responded to low dose ( i.e menopur 75IU , 150iu*1 ,2 and even 3 injections from day 2 to day 9 of periods.
    What should i do now?
    Is to have a child through ivf possible for me?
    Thank you



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