Ovarian Hyperstimulation

[mulligan]

Hi,

Does anyone know anything about ovarian hyperstimulation syndrome?
My ER is on Wednesday and my E2 level today was 5078. They are going through with the ER, but may have to freeze the embryos and do a frozen embryo transfer in a month or so depending on whether or not I overstimulate. I'm terrified that this is going to happen. Can anyone shed some light on this condition? Any tips on how to avoid it? FYI, I have 22 follicles and my E2 level has gone from 69 to 489 to 1752 to 5078. Very quickly. I'm only on day 8 of stims. Please help!

[sleepyfoy]

OHSS_ I had it during my first IVF 2 years ago... I had a "mild/moderate" case... could have fooled me.... It is when your ovaries get rather large and you retain a lot of H2O. Your clinic will do the best thing in your interest.. My IVF failed on the first try but my RE said that it had nothing to do with the OHSS. I had frozen embies... 3 months later I had a transfer and my little Jack was born 37 weeks later!!!!! There are a lot of symptoms your RE can share with you so you can be on the watch for.. I would STAY AWAY from info off the internet... Your RE is the BEST bet of information and you just need to trust in them that they would not put you or your babies health in danger....I promise.

Ain't gonna lie... It was very painful- but they monitered me very well and gave me excellent pain management meds that would not have hurt the babies or me.. They don't have an explaination to why my IVF failed... I guess it just wasn't the right time. I was sad, but happy that I had some to freeze and my little angel is sleeping away right now.. Talk to you RE clinic...Take care of yourself.. I have heard drink water to help- I don't know how much or why....

take care of yourself and let us know...
Jodi

[Ghost]

Most physicians would consider you to be at relatively high risk for OHSS under the most common protocol.

What did you use for down regulation?

Was it Lupron? Triptorelin? Synarel?

Or ganirelix? Maybe Cetrotide?

It makes a big difference regarding your options for avoiding OHSS.

Embryo freezing is a good way to avoid late OHSS. You could still get early OHSS from the hCG trigger, but it would fade quickly because of no pregnancy (embryos not transferred, no hCG production).

[mulligan]

I was taking lupron (5 units) along with my stims. I did the HCG trigger last night at 10:30 and have my retrieval tomorrow am at 10:30. I feel fine today, but think that if I am going to overstimulate it would be on Thursday. Dr. said that if I do, we'll freeze the embyos and transfer in 8 weeks when things calm down. Now I'm just waiting for tomorrow and on the look out for sudden weight gain and other symptoms of OHSS. I'm drinking plenty of fluids, praying and keeping my fingers crossed.

Ghost- is there anything else I can do?

Thanks!
M

[Ghost]

Ghost- is there anything else I can do?

Thanks!
M

Given that you were on Lupron, there was almost no choice but to trigger with hCG. hCG is a prerequisite for OHSS. Lupron itself makes a great trigger, instead of hCG, but you can't use it for both the trigger and down-regulation. Won't work at all.

You might ask your doctor about whey protein in combination with Gatorade. I've heard some great things about that. But few clinics are using it. Many are using intravenous albumin instead.

If you get OHSS, it won't last very long. As you know, there won't be a pregnancy to supply additional hCG.

[IVFmomof1]

OHSS is awwwwwful! I had to be hospitalized with it have fluid drained out of me twice. I hope you don't get it. I missed carried with that IVF pregnancy. Subsequent IVF cycles my estrogen got just as high but they put me on Metformin prior to stimming and i did fine and got pregnant x 2. Drink lots of water, high protein diet and rest for prevention. Good luck!!

[sleepyfoy]

Ghost...
You rock.
I am on the seoncd day of transfer and I am having trouble bending over. Of course it is after hours and I am drinking gatorade and eating protein and taking tylenol.... AFter transfer, could you hurt worse? I will of course call clinic tomorrow...
thanks
Jodi

[mulligan]

Ghost- you do rock! I agree with Jodi!

So, if I'm going to hyperstimulate, when will it be? I'm sure I'll know it when it happens, but what will it feel like? I'm expecting sudden weight gain, bloating, diahrea (sp?), vomiting, etc. I've been drinking water, gatorade and V8. I'm kind of looking forward to the no drinking after midnight ban before my retrieval so I don't have to drink anymore!!

If I haven't hyperstimulated before my transfer on Monday the 25th, can I still overstimulate then due to the hcg of a possible pregnancy?

thanks so much, you're the best!!

Mulligan

[Ghost]

Ghost...
You rock.
I am on the seoncd day of transfer and I am having trouble bending over. Of course it is after hours and I am drinking gatorade and eating protein and taking tylenol.... AFter transfer, could you hurt worse? I will of course call clinic tomorrow...
thanks
Jodi

Thanks for the kind words.

Not to alarm you, but OHSS can worsen with a pregnancy. The trigger shot will get your blood hCG level up to maybe 200-500 miu/ml in about 12 hours, after which it decreases over several days. Pregnancy will often get it into the 100,000-200,000 range within a few weeks of implantation.

So the answer is "yes", it can get worse. A lot worse. The good news is it usually doesn't.

Keep your doctor informed and follow instructions carefully.

[Ghost]

Ghost- you do rock! I agree with Jodi!

So, if I'm going to hyperstimulate, when will it be? I'm sure I'll know it when it happens, but what will it feel like? I'm expecting sudden weight gain, bloating, diahrea (sp?), vomiting, etc. I've been drinking water, gatorade and V8. I'm kind of looking forward to the no drinking after midnight ban before my retrieval so I don't have to drink anymore!!

If I haven't hyperstimulated before my transfer on Monday the 25th, can I still overstimulate then due to the hcg of a possible pregnancy?

thanks so much, you're the best!!

Mulligan

Thanks.

OHSS has two possible onsets. Early onset can follow the hCG trigger. Late onset can follow the hCG rise produced by a pregnancy.

Again, keep your clinic informed and follow instructions carefully.

Best of luck to both you and Jodi!!!

[mulligan]

Just to keep you updated....

They did my retrieval today and got 26 eggs! I'm encouraged by that number, but I'm also aware that a higher number of eggs retrieved puts me at an even higher risk for OHSS. What I think is good news is that my E2 level dropped from 5078 on day 8 to 3600 on day 9. I was expecting it to go up to 7000.

Ghost- what do you think of retrieving 26 eggs? Is that good? What usually happens to the eggs? Do you know what percentage fertilize? Divide properly? Are of good quality?

Thanks!

M

[Ghost]

Just to keep you updated....

They did my retrieval today and got 26 eggs! I'm encouraged by that number, but I'm also aware that a higher number of eggs retrieved puts me at an even higher risk for OHSS. What I think is good news is that my E2 level dropped from 5078 on day 8 to 3600 on day 9. I was expecting it to go up to 7000.

Ghost- what do you think of retrieving 26 eggs? Is that good? What usually happens to the eggs? Do you know what percentage fertilize? Divide properly? Are of good quality?

Thanks!

M

The best predictor of OHSS is the follicle count. 26 eggs suggests your follicle count was near 26. That's on the high side, but not at all extreme. I've seen double that and much more. Your risk of severe OHSS might be around 5%??? That's just a wild guess. Your doctor will have much more specific information on your cycle (like your follicle count) and can better estimate your OHSS risk. Again, without a fresh transfer, any OHSS from the trigger won't last long. However, if you have a fresh transfer and late onset of OHSS (caused by hCG from the pregnancy), then that OHSS could last awhile.

You'll have to wait and see how many fertilize and make it to whatever stage your clinic uses for freezing/transfer. You seem to be pretty well off. Many patients would envy your egg yield.

Hope this helps. Best of luck to you.

[mulligan]

Thanks, Ghost. Your expertise is comforting and very much appreciated.

M

[lj]

OHSS is awwwwwful! I had to be hospitalized with it have fluid drained out of me twice. I hope you don't get it. I missed carried with that IVF pregnancy. Subsequent IVF cycles my estrogen got just as high but they put me on Metformin prior to stimming and i did fine and got pregnant x 2. Drink lots of water, high protein diet and rest for prevention. Good luck!!

Hi, I am just starting metformin, even though like you I have no pcos or insulin resistance - I overstim too. I am also in Atlanta and would like to chat further. Please reply if you would be willing to share more of your experience. Thanks.

[MrsDanielleTTC#1_5.5yrs]

I will be having my FET in a few weeks 7-03-07. . I had OHSS so bad that my RE said that he was going to send me to another RE if I don't get preg with these 8 snowbabies. Seven BL day 5, 8 cells and one BL day6, 8 cell. At the time of freezen they where grade A. I was in the hospital for 4 days I believe I went home around 10 or 11 o'clock by 4 o'clock I was back this time in ICU. for about 6 or 7 days. RE said to wait 3 months. So we are here. I will stop my lupron on 6-28, I will put on the vivelle dot patch 6-26 before my Dr.'s appt. changeing it every three days. I will also be starting my Prometruim on Wed. 7-28 200mg every eight hours vaginally. I have been on Estrace for a week now two 2mg tab every 12hours. My cell phone is set to ring for all these different hours for the meds. I really do think that I am doing very good because I am not a med. taker.
Good luck to all and Sticky baby dust to all.
Danielle