OHSS - Ghost or anyone with experience?

[kizmet]

Hi

Quick background - this is my first round of IVF. I have PCOS, was on synarel nasal spray and 150units of Puregon (FSH) with few symptoms other than slight ovarian pain. Some sickness when I did the hcg trigger but not too bad. Egg collection on Tuesday (14 eggs) left me in extreme pain and eventually I went to the emergency department on Wednesday and was hospitalised last night (I'm in Australia, so a day ahead of most of you). Ultra sound and BW indicated OHSS with large amounts of capillary bleeding into my abdomen. Still naseaus today but the pain is under control and I was released. They still think they will do the ET on Sunday. If the symptoms return post ET will it be as bad? I'm not sure I can handle another round of these symptoms right now?

Thanks in advance,
Kiz

[Ghost]

Hi

Quick background - this is my first round of IVF. I have PCOS, was on synarel nasal spray and 150units of Puregon (FSH) with few symptoms other than slight ovarian pain. Some sickness when I did the hcg trigger but not too bad. Egg collection on Tuesday (14 eggs) left me in extreme pain and eventually I went to the emergency department on Wednesday and was hospitalised last night (I'm in Australia, so a day ahead of most of you). Ultra sound and BW indicated OHSS with large amounts of capillary bleeding into my abdomen. Still naseaus today but the pain is under control and I was released. They still think they will do the ET on Sunday. If the symptoms return post ET will it be as bad? I'm not sure I can handle another round of these symptoms right now?

Thanks in advance,
Kiz

Is your abdomen distended with fluid?

Yes, it can return and become much worse and more prolonged if a pregnancy occurs in this cycle.

Your stimulation caused you to develop many follicles. At least 14, in your case. When hCG hit those follicles, they each matured their egg, which was then extracted surgically. The remaining follicle becomes a gland called a corpus luteum. A corpus luteum, when acted on by hCG (or LH) produces progesterone and other hormones. Progesterone is important for the pregnancy, as it prevents menses from washing away an implanting embryo. One of the other hormones is called VEGF, a hormone that promotes vascularization (the localized growth of blood vessels). A little VEGF in your system is usually no problem because you have inert receptors in your bloodstream that will just absorb it. However, if you have many follicles (as you do), then lots of VEGF can overwhelm those receptors and then cause trouble. Excessive VEGF causes vascular hyperpermeability. That means your capillaries become too permeable and allow fluid to pass through them (not blood, the blood cells still cannot get through). That fluid accumulates in the "Third space" in your abdomen, and sometimes around the lungs.

The hCG from the trigger fades in 7-10 days. But at about 10 days, the embryo can be making enough hCG to stimulate the corpora lutea again, and that means more VEGF. hCG levels in a pregnancy quickly rise to be much greater than from a trigger. Maybe 1000 times as great in a few weeks. So yes, the OHSS can return and can be a lot worse then, and it can take weeks to resolve.

One solution is to freeze the embryos and let the corpora lutea die off. Then transfer the frozen embryos in a later cycle.

[kizmet]

Thanks Ghost. To be honest, the prospect of getting it again after ET terrifies me. I've never been this sick. My belly was very distended and tight - couldn't even bare to wear PJ's or underwear or even covers on the bed for a while. The ob/gyn in the hospital, who was not an IVF expert, told me the progesterone, which I am due to start tomorrow, should have no effect on my current symptoms. I think I will ring the clinic in the morning and discuss it directly with them.

I did have a lot of follicles and they only collected eggs from those over 10mm, so there are still some follicles there according to yesterday's ultrasound. I have 6 good quality embies and 4 still under consideration, so perhaps a FET would be better.

Thanks again.
Kiz

[Ghost]

Thanks Ghost. To be honest, the prospect of getting it again after ET terrifies me. I've never been this sick. My belly was very distended and tight - couldn't even bare to wear PJ's or underwear or even covers on the bed for a while. The ob/gyn in the hospital, who was not an IVF expert, told me the progesterone, which I am due to start tomorrow, should have no effect on my current symptoms. I think I will ring the clinic in the morning and discuss it directly with them.

I did have a lot of follicles and they only collected eggs from those over 10mm, so there are still some follicles there according to yesterday's ultrasound. I have 6 good quality embies and 4 still under consideration, so perhaps a FET would be better.

Thanks again.
Kiz

Your ob/gyn is correct. Progesterone has nothing to do with causing OHSS symptoms.