In recent years, the method of in vitro fertilization (IVF) has been widely used. With this method, at the initial stage, they often resort to the procedure of ovulation stimulation. For this, hormonal drugs are taken. Few people before this examine a woman in full, which leads to complications, life-threatening consequences. Against the background of the use of hormonal agents to stimulate ovulation, such a complication as ovarian hyperstimulation syndrome (OHSS) often appears. This syndrome is manifested by an increase in the size of the ovary. In this case, the ovary can reach up to 12 cm in diameter. How could such a situation be dangerous?
Why do the ovaries enlarge when ovulation is stimulated?
Gonadotropic substances and clomiphene are used to stimulate ovulation. It has been established that the use of gonadotropic substances leads to the development of OHSS several times more often than clomiphene. There is a direct relationship between the dose of hormones and the duration of use.
The ovarian follicles contain fluid, which is a highly active biological medium. When ovulation is stimulated, the amount of fluid increases greatly. The concentration of progesterone, estradiol, histamine, prostaglandins in the blood and metabolic products also increases. In OHSS, an increased concentration of the carcinoembryonic antigen CA-125, a tumor marker, is detected.
When ovulation is stimulated, a process takes place in the body that has yet to be explained by science. This is a change in the permeability of the vascular wall. Rapid filtration of the liquid part of the blood causes hypovolemia, which reduces the perfusion of the kidneys, disturbed water - electrolyte balance. This causes azotemia and hyperkalemia.
As a result, many pathological processes are triggered in the body, which require immediate correction and threaten the patient's life. Hypovolemia provokes hypotension, increased hematocrit, tachycardia. There is increased blood clotting, poor urine output and azotemia. All this is caused by substances that are in the follicular fluid.
With these processes, there is a significant increase in the ovary, it has a large number of cysts, the stroma is edematous. The cysts contain clear fluid. The uterus and fallopian tubes remain unchanged.
Clinical manifestations of OHSS during ovulation induction
Manifestations of ovarian hyperstimulation syndrome during ovulation stimulation appear 3-8 days after drug administration. During pregnancy, the syndrome is very difficult. These data give grounds to think that CG plays an important role in OHSS. Clinical manifestations of excessive stimulation of ovulation depend on the severity of the process.
- With a mild form, there are practically no symptoms. Estradiol in the blood more than 150 mcg, pregnadiol in the urine more than 10 mg. The ovary is enlarged up to 5 cm in diameter.
- With an average degree, heaviness and pain in the lower abdomen joins the above described symptoms. There may be nausea, vomiting, and diarrhea. The ovary at this stage is enlarged to 12 cm in diameter.
- In severe stages, hydrothorax, ascites, hypercoagulability develop. With excessive stimulation of ovulation, kidney function is significantly impaired with a decrease in perfusion, which threatens the development of renal failure. At this stage, ovarian rupture or torsion is more common. At this stage, the woman should be hospitalized immediately.
The main symptom of a problem with ovulation induction is ovarian enlargement, which in most cases a woman can notice or feel herself. At the first suspicion of this, you should immediately contact a specialist.
Principles for the treatment and prevention of OHSS in ovulation induction
If a woman has mild OHSS with ovulation induction, she needs constant monitoring to control ovarian enlargement. It is also important to determine the level of estradiol in the blood plasma every day. If moderate severity is detected, it is advisable to prescribe glucocorticosteroid drugs in combination with antihistamine and antiprostaglandin drugs.
The severe form should be corrected with intensive care and aimed at maintaining a normal circulating blood volume.
The following drugs are used to treat such patients:
- agents that will retain fluid in the vascular bed (albumin, plasma, proteins);
- low molecular weight dextrans to stimulate diuresis;
- corticosteroid drugs, antihistamines and antiprostaglandins to reduce the permeability of the vascular wall.
Sometimes aspiration of fluid through the posterior vaginal fornix is indicated. Such a need appears with ascites. Naturally, all actions and manipulations are performed under the control of the electrolyte state, hematocrit, coagulogram and diuresis. Surgical intervention is indicated for rupture or torsion of the ovary.
The prognosis for mild to moderate ovarian enlargement is favorable. A severe form threatens the health and life of a woman.
To prevent such dangerous conditions, it is important to select patients for ovulation stimulation by determining the initial level of estrogen in the urine or blood, as well as the size of the ovaries using ultrasound. Doses of drugs should be selected individually. The initial doses are minimal, they are gradually increased. When using drugs, it is important to control the level of estradiol.
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