Egg donation is a lengthy and laborious process involving several medications and tests. One of the potential serious risk factors for egg donors is the chance of developing ovarian hyperstimulation syndrome (OHSS) during fertility treatment. Although it is important to be aware of OHSS, research indicates that the risk is insignificant, and women should not be overly concerned.
Most practices take adequate precautions to eliminate the chances of developing OHSS. Moreover, OHSS is a potential concern only for egg donors and not for the recipients, during the egg donor process. This article touches on factors contributing to ovarian hyperstimulation syndrome and ways of prevention.
Fertility medications are associated with common side effects, such as moderate weight gain, mood changes, stomach pressure, headaches and allergic reaction. In particular, follicle stimulating hormone (FSH) and human menopausal gonadotropin (hMG) are associated with the potential risk of ovarian hyperstimulation syndrome.
The risk of moderate or severe OHSS per cycle is less than 5%.
OHSS is characterized by enlarged ovaries, significant fluid retention in the abdomen and increased blood concentration, due to dehydration. Mild cases of OHSS, although uncomfortable, tend to resolve in a few days.
In very rare cases, severe forms of OHSS are encountered during egg donation procedures, which may necessitate hospitalization. Severe OHSS cases present the risk of developing blood clots, excessive fluid retention in the abdomen and lungs, kidney failure, ruptured ovaries, or stroke. Symptoms usually last less than a week.
Prevention
The best prevention for OHSS is the judicious use of injectable FSH during fertility treatment. An optimal ovarian stimulation protocol should be chosen depending upon the women’s response and risk factors. Women with high antral follicle counts, high anti-mullerian hormone (AMH) levels, high luteinizing hormone (LH) blood levels and high LH to FSH ratios are at a higher risk for developing OHSS.
Therefore, a proper dosing and treatment regimen should be selected for these susceptible individuals. In addition, the egg donor should be monitored closely and frequently to evaluate their response to injectable FSH.
A gonadotropin-releasing hormone agonist (GnRH agonist)
trigger instead of an HCG trigger shot to prepare for the egg retrieval, can be used to reduce the chances of developing OHSS. In this case, the GnRH agonist replaces hCG to induce an LH surge in the egg donor. However, if the donor has already been given Lupron prior to ovarian stimulation process, this approach will not work.
Another approach undertaken by fertility clinicians is to stop FSH administration for 1– 3 days prior to the hCG trigger. This approach is useful for women who display high number of developed follicles along with high
estradiol levels.
The use of cabergoline around the time of HCG trigger has also shown to decrease the incidence of OHSS.
Management
Mild to moderate OHSS can be managed with oral pain medications. If the symptoms worsen, physical examinations and ultrasounds can be performed to measure the ovaries. Fluid retention in the body can be assessed by routinely measuring the donor’s body weight. Moreover, blood tests can be performed to check complete blood counts, electrolytes and creatinine levels.
Severe cases of OHSS require hospitalization. The symptoms for hospitalization include severe abdominal pain, severe nausea and vomiting, very low blood pressure, serious abnormalities in the blood test results and very low urine output.
Colorado Center for Egg Donation offers premier services for women who desire to be either an egg donor or egg recipient. Patients are seen from all over the Midwest and Medical Director Dr. Deborah Smith has been named a Top 5 Fertility Doctor Nationwide by HealthTap!
Comprehensive treatments are offered and there are options for shared recipients to save on cost if desired. For those interested in ART such as egg donor Denver trusts, call Colorado Center for Egg Donation today at
(720) 390-3931