What happens in the body
To obtain several eggs, the ovaries are stimulated with hormonal drugs. If the response is excessive, many follicles mature in the ovaries, and they produce substances that increase the permeability of the vascular wall. The liquid part of the blood leaves the vessels and accumulates in the abdominal cavity, less often in the chest. As a result, the abdomen enlarges, and the blood in the vessels thickens: the hematocrit increases, the risk of blood clots increases, and the blood supply to the kidneys worsens. The key triggering factor is the hCG hormone, both administered for the final maturation of eggs and produced during pregnancy.
- Excessive ovarian response to stimulation
- Increased vascular permeability
- Fluid accumulation in the abdominal cavity
- Blood thickening and risk of thrombosis
- Decreased blood supply to the kidneys
- Early form a few days after puncture
- Late form during pregnancy
Who's at risk
The risk is higher in younger, lighter women, whose ovaries are especially responsive. The classic group is patients with polycystic ovary syndrome, high levels of anti-Mullerian hormone and a large number of antral follicles on ultrasound. The protocol itself is also important: high doses of drugs, the use of hCG for final maturation, a large number of eggs obtained. A separate factor is the onset of pregnancy, especially multiple pregnancy: your own hCG supports the process, and the syndrome develops later and is more severe. The doctor’s experience and individual selection of the protocol help prevent complications.
- Age under 35 years and low body weight
- Polycystic ovary syndrome
- High anti-mullerian hormone
- Many antral follicles
- Large number of eggs obtained
- Using hCG as a trigger
- Current, especially multiple, pregnancy
- Overstimulation in past attempts
Severities and symptoms
With a mild degree, bloating, heaviness and moderate pain in the lower abdomen, mild nausea are a concern; This condition occurs frequently and goes away in a few days. The average degree is manifested by a noticeable enlargement of the abdomen due to fluid, weight gain, vomiting, and ultrasound shows enlarged ovaries and free fluid. The severe form is a tense abdomen, shortness of breath due to the high position of the diaphragm and fluid in the chest cavity, a sharp decrease in urination, and thickening of the blood. It is with a severe form that the risk of thrombosis increases, so delay is unacceptable.
- Bloating and heaviness in the lower abdomen
- Pain that gets worse with movement
- Nausea and vomiting
- Fast weight gain
- Increased abdominal volume
- Shortness of breath and difficulty breathing while lying down
- Decreased urine output
- Weakness, dizziness, rapid pulse
Survey
A combination of complaints, examination data and tests is assessed. The weight and volume of the abdomen are monitored daily, and the amount of urine excreted is counted. The main thing in a blood test is the hematocrit, which reflects the degree of thickening, and the level of leukocytes. Albumin, electrolytes, creatinine and urea are checked to evaluate the kidneys, liver function tests and a coagulogram with an indicator reflecting the risk of thrombosis. Ultrasound shows enlarged ovaries with multiple cavities and the amount of free fluid in the abdominal cavity. In case of shortness of breath, the condition of the chest cavity is additionally assessed.
- Control of weight, abdominal circumference and urine output
- Complete blood count with hematocrit
- Albumin and total protein
- Creatinine, urea, electrolytes
- Liver tests
- Coagulogram and markers of thrombosis
- Ultrasound of the ovaries and abdominal cavity
- Assessment of pleural cavities for shortness of breath
Treatment and prevention
Mild forms are managed at home: rest without bed rest, sufficient drinking, food with a high protein content, daily weighing and contact with a doctor. Severe forms are treated in a hospital: solutions are administered to replenish blood volume, albumin if necessary, medications are prescribed to prevent thrombosis, and in case of a tense abdomen and shortness of breath, fluid is released through a puncture under ultrasound guidance. Prevention begins in advance: individual selection of doses, use of another trigger option instead of hCG, refusal to transfer embryos in this cycle with their freezing.
- Rest without complete immobility, sufficient drinking
- High Protein Meals
- Daily weighing and urine output monitoring
- Hospitalization for severe cases
- Infusion therapy and albumin
- Prevention of thrombosis as prescribed by a doctor
- Ultrasound-guided puncture and fluid removal
- Individual selection of stimulation protocol
- Delayed embryo transfer with cryopreservation
