Ovarian Hyperstimulation Syndrome Blog

Ovarian Hyperstimulation Syndrome: Should I be Worried?

For many egg donors, having the opportunity to help another person or couple realize their dream of building a family is an amazing and rewarding experience. Giving someone else the potential gift of parenthood is a very generous and altruistic act. Many donors also value the compensation they receive, which can meaningfully contribute toward their current expenses or future plans.


While egg donation is often a source of great happiness and fulfillment for egg donors, it is a process that carries some degree of risk and could cause some potential side effects like all medical procedures. A common concern for many egg donors is how the donation process may increase their risk of developing ovarian hyperstimulation syndrome (OHSS). While OHSS may seem scary and possibly not worth the risk of egg donation, it’s important to get the facts about this rare (and rarely serious) condition, so you have a more realistic and accurate picture of how likely you are to be impacted by it (hint: not likely!).


What is ovarian hyperstimulation syndrome (OHSS)?

OHSS is a condition in which the ovaries swell and leak fluid into the body. OHSS is a possible complication in women receiving fertility treatment or undergoing the egg donation process. In both scenarios, injectable hormone medications are used to stimulate the ovaries to produce a high number of eggs for retrieval. In rare cases, some women are more sensitive to stimulation medications. The result is excessive swelling of the ovaries and the leakage of fluid, which can lead to unexpected weight gain, bloating, and pain.


How common is ovarian hyperstimulation syndrome (OHSS)?

While OHSS may sound frightening, it’s important to know that the condition is exceedingly rare and often results in temporary and relatively mild symptoms that usually resolve on their own. Less than 5% of women undergoing fertility treatment develop OHSS, and less than 1% of women develop severe symptoms and complications.


OHSS is also more common in women receiving fertility treatments who also have polycystic ovarian syndrome (PCOS), a hormonal disorder common among women of reproductive age. However, many women with PCOS are not considered eligible to donate. If you have PCOS and are given the green light to donate your eggs, your Ovatures care team will carefully monitor your body’s response to the medication regimen to watch out for OHSS.


The important takeaway here? Egg donation is generally a very safe and low-risk process. When you become an egg donor, your care team at Ovatures will work closely with you to monitor your experience throughout the donation process and be sure to ask any questions you have about OHSS and discuss any symptoms you experience.


What causes ovarian hyperstimulation syndrome (OHSS)?

While the exact cause of OHSS is unknown, the condition typically develops due to the body’s exaggerated response to high levels of a hormone called human chorionic gonadotropin (HCG). During the egg donation process, high levels of HCG occur following injectable fertility medications that stimulate the ovaries to produce an increased number of eggs at once. In rare cases, a high level of HCG can cause the blood vessels in the ovaries to swell abnormally and leak fluid. This fluid can cause the ovaries to swell, and the extra fluid can also leak into the abdomen.


Injectable fertility medication is more likely to cause OHSS than oral fertility medication. In rare cases, OHSS can develop spontaneously in women with genetic abnormalities that can increase their risk of developing OHSS, even if they are not undergoing fertility treatment.


What are the risk factors for developing ovarian hyperstimulation syndrome (OHSS)?

Even though OHSS is rare, some factors could increase your risk of developing OHSS during the egg donation process. These include:

  • Having a large number of follicles during the stimulation phase
  • Having a high level of estrogen during the stimulation phase
  • Receiving high doses of HCG injections (which trigger ovulation) during the egg donation process
  • Having a high or sharply increasing level of estradiol before an HCG injection
  • A previous diagnosis or episode of OHSS

Other factors that could increase your risk for developing OHSS that are not related to the egg donation process itself include:

  • Having polycystic ovary syndrome (PCOS)
  • Being under 35 years old
  • Having low body weight/being underweight

While some cases of OHSS can’t be prevented, if you are concerned about developing OHSS during the egg donation process, speak with your care team about assessing your risk level and what steps you and your care team can take to reduce your risk.


What are the symptoms of ovarian hyperstimulation syndrome (OHSS)?

In OHSS, the ovaries’ swelling and the fluid leakage into the abdomen can lead to a range of symptoms, which can develop within one to two weeks after using injectable fertility medications to stimulate ovulation. Symptoms can vary from mild to more serious, depending on the severity of the condition, and they may improve or get worse over time.

In mild to moderate cases of OHSS, symptoms may include:

  • Mild to moderate abdominal pain or pressure
  • Tenderness near the location of your ovaries
  • Abdominal bloating or swelling
  • Slight weight gain (due to the accumulation of extra fluid)
  • Nausea
  • Vomiting
  • Diarrhea

In more severe cases of OHSS, symptoms may include:

  • Rapid and excessive weight gain (more than 2 pounds in 24 hours)
  • Severe abdominal pain or swelling
  • Severe nausea and vomiting
  • Blood clots
  • Decreased or more infrequent urination
  • Shortness of breath

If you experience any of the above symptoms during the egg donation process – even if your symptoms are mild – tell your care team immediately so they can evaluate you for OHSS, monitor your symptoms, and provide treatment if needed. Seeking early intervention can help prevent the condition from worsening and reduce the risk of further complications.


How is ovarian hyperstimulation syndrome (OHSS) diagnosed?

If you’re experiencing any symptoms of OHSS, your doctor can diagnose the condition by administering a few tests. These tests can include:

  • Physical exam – The doctor will look for rapid or unexpected weight gain, measure your waist to check for signs of severe bloating, and evaluate any other symptoms you are experiencing.
  • Ultrasound – This imaging exam will check for fluid in your abdomen. It will also check the size of your ovaries to determine the severity of OHSS.
  • Chest X-ray: This imaging exam will look for fluid in your chest.
  • Blood tests: These will determine if you have excessive or abnormally high amounts of certain hormones that can indicate OHSS and determine how your kidneys are functioning.


What is the treatment for ovarian hyperstimulation syndrome (OHSS)?

Treatment for OHSS typically depends on the severity of the condition. In mild to moderate cases of OHSS, the condition will generally resolve on its own within two weeks. To relieve any discomfort and prevent complications, you will likely need to:

  • Rest and engage in only light physical activity
  • Drink extra fluids to stay hydrated
  • Avoid caffeine and alcohol to prevent dehydration
  • Take acetaminophen to relieve any physical discomfort
  • Weigh yourself daily to look for any sudden or unexpected changes in your weight
  • Measure your abdomen to check for a sudden increase in size
  • Undergo more frequent physical exams, ultrasounds, or bloodwork
  • Monitor the frequency of urination

If you have a more severe case of OHSS, you will likely require more aggressive treatment and possibly hospitalization (but remember, severe cases are quite rare!). Your treatment plan may include:

  • Adjusting the doses of the fertility medications needed to complete the egg donation process
  • Receiving intravenous (IV) fluids
  • Having a procedure to remove the extra fluid in your abdomen
  • Taking medication to relieve your symptoms or reduce ovarian activity


What are the complications of ovarian hyperstimulation syndrome (OHSS)?

While severe cases of OHSS are very rare, the condition can cause serious complications that require prompt medical attention, such as:

  • Fluid in the chest that can cause chest pain or difficulty breathing
  • Kidney failure
  • Ovarian torsion (the twisting of an ovary)
  • Rupture of an ovarian cyst associated with OHSS

Seeking medical care as soon as possible can help prevent OHSS from worsening, so raise any concerns, questions, or new symptoms with your care team.


How do you prevent ovarian hyperstimulation syndrome (OHSS)?

Many cases of OHSS can’t be prevented, but your care team will take every precaution to reduce your risk throughout the egg donation process. They will design a personalized medication plan based on your unique needs, and you will be monitored closely and regularly at your appointments. Your care team will check your progress and your body’s response to the fertility medications with regular ultrasounds and bloodwork to catch any warning signs of OHSS as early as possible. In addition, your care team may also reduce your risk for OHSS by:

  • Adjusting medication: You may be prescribed the lowest possible dose of HCG.
  • Adding medication: Your care team may add medications to your treatment plan that can help prevent hyperstimulation or reduce the swelling of your ovaries.
  • Coasting: During the egg donation process, your care team may ask you to stop injectable medications for a few days before giving HCG to allow your hormone levels to reduce and regulate.
  • Opting for an HCG injection alternative: Since OHSS often develops following an HCG injection, your care team may prescribe an alternative option that will still trigger ovulation but lower your risk for OHSS.


So…do I need to be worried about ovarian hyperstimulation syndrome (OHSS) if I become an egg donor?

While it’s true that OHSS is a potential risk of undergoing the egg donation process, it’s important to keep three points in mind:

  • OHSS is quite rare (occurring less than 5% of the time!).
  • When it does occur, symptoms of OHSS are typically mild or moderate.
  • OHSS will typically clear up on its own within a few weeks.

Unfortunately, nothing in life is risk-free, and egg donation is no exception. However, for many egg donors, the reward of potentially helping prospective parents build their families far outweighs the small risk of developing OHSS. So, if you’re considering becoming an egg donor, discuss OHSS with your care team, get your questions answered, and assess your own personal risk. Knowledge is power and learning more about OHSS will help ensure the egg donation process is both a safe and truly meaningful experience!



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