Ovarian Hyperstimulation Syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS) can occur following ovarian stimulation for either a superovulation-IUI or an In Vitro Fertilization cycle. Symptoms generally begin 4-6 days after hCG administration. While the exact mechanism of how OHSS develops is unknown, what is known is that vasoactive substances are produced which cause the ovaries and capillaries (small blood vessels) to become ‘leaky’. This ‘leakiness’ causes protein to leave the vascular system and the protein shift pulls water out of the blood vessels and into the body’s ‘third-space’. Basically, the ‘third space’ means anything outside the blood vessles. Fluid collects in the abdomen, around the lungs and heart, & into and around soft tissues. Symptoms include pain (enlarged ovaries) and bloating, weight gain (retained fluid in the third space), dehydration (the fluid leaves the blood vessels), shutdown of the kidneys, and difficulty breathing (fluid around the lungs). Symptoms become more pronounced as activity increases. Virtually all women who take ovarian stimulating medications have mild degrees of OHSS; however, OHSS is a lifethreatening disease in its most severe form.


Common Symptoms of Ovarian Hyperstimulatioon Syndrome (OHSS):

Weight gain

Abdominal bloating, swelling, discomfort or pain

Shortness of breath or inability to breathe deeply without discomfort


Signs of Moderate to Severe Ovarian Hyperstimulation Syndrome (OHSS):

Please contact the office if you experience any of the following: Weight gain of 3 lbs in any 24 hour period or difficulty sleeping because of pain and/or difficulty breathing.


Patient Instructions:

  1. Weigh yourself each morning and keep a record. A weight gain of 3lbs or more in a 24hr period must be reported to the office.
  2. Purchase a devise from your pharmacy that will allow you to accurately measure your urine output, this is usually referred to as a urine "hat". Call the office if your urine output is less than 240cc’s in an 8 hour period. Also notify us if your urine appears dark and very concentrated.
  3. If instructed to limit your fluid intake, limit your fluids to 2 quarts of Gatorade (or similar product, any flavor) per day. Avoid plain water or tea. Keep a written record of your input and your output, they should be fairly equal. Any discrepancies should be reported to the office.
  4. While standing, have your partner measure your abdominal girth at its largest point with a measuring tape and mark the skin with a felt tip marker. Measure at this precise point daily, and report gain of 1/2 inch or more.
  5. Do not lift, push, or pull any objects greater than 15lbs.
  6. Do not engage in any strenuous physical activity. Your overall activity should be limited. If bedrest has been recommended maintain this until further notice. Bedrest means that out of bed activity should be limited to showering/bathing and use of the toilet. No housework; no puttering around the house.
  7. A high protein diet is recommended. Eat small frequent meals. Avoid foods that are high in water content. Salty foods are fine.