OHSS

*This is the Dr. Jill version and I am using the knowledge I gained through my personal experiences and my doctors. I am not an expert.

Ovarian Hyper Stimulation Syndrome (OHSS) is experienced by up to 30% of IVF patients and can come in the form of mild, moderate or severe. You guessed it, I got it -- lucky me! Thankfully it wasn't until my third cycle. If I had it during my first cycle I'm not sure our journey would have been the same at all. OHSS is a fairly complex syndrome but simply put it is when a woman has high levels of hormones in her system (over stimulated) and her body doesn't like it. Once she 'triggers' with HcG hormone shot 36 hours before egg retrieval, she begins to feel symptomatic almost immediately. My ovaries ended up swelled to the size of grapefruits (they are usually the size of an almond! OUCH!) and has taken close to three months to decrease in size. Everyone experiences different OHSS symptoms and at different times.  It is so important to keep your fertility Doctor in the loop if you think you might be experiencing OHSS.  I didn't hesitate calling or emailing when I was concerned and even barged into the clinic without appointments when I was feeling absolutely terrible. Remember that your doctor has a ton of patients so you need to be on your A-game to watch for warning signs/symptoms -- you are your best advocate. Trust me, you don't want OHSS to get to the severe point. Here are the symptoms I experienced;

Days 1- 3 Post Egg Retrieval:
- Feeling worse then egg retrieval day (you should be feeling a little better with each passing day)
- No appetite
- Nausea
- Sore/tender abdomen
- abdomen bloat
- uterine pain

Day 4 Post Egg Retrieval:
- same as symptoms above
- pain while urinating
- dark urine
- less urine output
- My weight remained steady however I wasn't really eating because of the nausea

Day 5 Embryo Transfer:
- Doctor put me on medication for OHSS for the next 10 days
- Began to feel relief immediately
- All symptoms slowly faded over the following 5 days
Doctors Orders: On top of taking my prescription I was told to take regular Tylonol for the pain and to decrease fluid intake and only drink water/Gatorade when thirsty.  This ended up being about 3 bottles of water/Gatorade per day. Rest lots but get up every so often to move around to prevent blood clots.

Days 6-12 Post Embryo Transfer:
- Intense cramping/contractions in uterus that would come and go every few hours but last for about 15 minutes.  The contractions were debilitating - they made me sick to my stomach and I'd have to lay down on my side. I was brought to tears through most of them.
- Abdomen bloat returned
- very low energy
- Very full feeling in my uterus
- No appetite (weight still steady)
Doctors Orders: Fluid was found in my abdomen that was causing these symptoms.  Was told to take regular Tylonol for the pain and to decrease fluid intake to 1 bottle of Gatorade a day. Sips of water only when thirty. Rest lots but get up every so often to move around to prevent blood clots. 10 days after our transfer date we received our positive pregnancy result.  It was explained to us that when you become pregnant you body begins to make the HcG hormone.  This is the same hormone that caused the original symptoms 36 hours prior to my egg retrieval, thus why I started to experience symptoms again on day 6 post transfer.  This is when our lil' babe implanted.

Days 13-15 Post Embryo Transfer:
- same of symptoms above
- I began experiencing difficulties breathing - shortness of breath (walking up stairs was hard)
- When I bent over I had chest discomfort/pain
Doctors Orders: Fluid found in lungs. Will re-evaluate in two days to see if fluid increases or decreases.  If increased I'd be admitted to the hospital to drain my abdomen and lungs. I immediately went in to see my acupuncturist who was able to do use pressure  points that would encourage the fluid to drain.

Day 16 Post Embryo Transfer:
- energy levels began to increase
- feeling a lot better
Doctors Orders: Fluid was draining on its own (THANK YOU ACUPUNCTURE!!!). Over the next few days slowly begin to increase fluid intake. Take it easy and don't get heart rate up too much. Great! I started work three days after this!

Days 17-30 Post Embryo Transfer:
- With each passing day I started to feel so much better!

 Below is a chart that outlines common signs and symptoms. This chart is from http://www.ivf.com/ohss.html

SIGNS AND SYMPTOMS	WHY IT HAPPENS	WHAT TO DO
Mild You may experience: - Abdominal bloating and feeling of fullness - Nausea - Diarrhea - Slight weight gain	This may be due to: - Ovaries are larger than normal, tender and fragile - High level of estrogen (E2) and progesterone in the bloodstream may upset your digestive system and fluid balance causing bloating.	Recommended treatment: - Avoid sexual intercourse - Do not have a vaginal (pelvic) exam other than by one of our physicians - Reduce activities, no heavy lifting, straining or exercise - Drink clear fluids, flat coke, ginger ale, cranberry juice, Gatorade or Ensure
Moderate You may also experience: - Weight gain of greater than 2 lbs. per day (excessive weight gain) - Increased abdominal measurement causing clothes to feel tight - Vomiting & diarrhea - Urine is darker and amount is less - Skin/hair may feel dry - Thirst	This may be due to: - High levels of hormones in the bloodstream upset the digestive system - Fluid imbalance causes dehydration because body fluids collect in the abdomen and other tissues - This fluid collection causes severe bloating	As noted above plus: - Call our nurses - You may need to be seen by a physician who will do an ultrasound - Record your weight twice daily - Record the number of times you urinate each day - Contact our office if you note a five pound weight gain over the previous 24 hours, note a drop in the frequency of urination (~50%), or increasing pelvic pain
Severe You may also experience: - Fullness/bloating up above the belly button - Shortness of breath - Urination has reduced or stopped and become darker - Calf pains and chest pains - Marked abdominal bloating or dissention - Lower abdominal pain	This may be due to: - Extremely large ovaries - Fluid collects in lungs and/or abdominal cavity, as well as in tissues - The risk of abnormal blood clotting increases	As noted above plus: - Notify the physician on call - You may need to be assessed at the hospital or our clinic - Excess fluid may need to be removed from your abdominal cavity