During an egg donation cycle, injectable medication called gonadotropins are prescribed, which, in an environment of controlled ovarian hyperstimulation, promotes follicular growth, which allows for the retrieval of several mature eggs.
Unfortunately, a small number of egg donation cycles lead to a state of uncontrolled ovarian hyperstimulation (OHSS), which may result in significant discomfort that may, in turn, require medical intervention. While some patients experience mild OHSS symptoms not considered clinically significant, such as bloating and mild weight fluctuations following egg retrieval, for a very small number of patients, especially those with polycystic ovarian syndrome or high estradiol levels just before egg retrieval, the risks of severe OHSS is real.
What Causes Ovarian Hyperstimulation Syndrome?
OHSS is most commonly associated with the hormone injection, human chorionic gonadotropin (hCG), administered as a “trigger” shot to promote the last stage of maturation of the growing follicles, approximately 35-36 hours before egg retrieval. Further, patients who show signs of polycystic ovarian syndrome are at higher risk for OHSS, and finally, pregnancy (and even more so, a multiple pregnancy) immediately following egg retrieval (such as what happens with IVF patients having their own eggs retrieved and then embryos transferred), increases the likelihood and the duration of OHSS. While egg donors are at some risk for developing OHSS, their risk is low levels are low compared to other patient demographics.
What Are The Symptoms of Ovarian Hyperstimulation Syndrome?
Mild OHSS symptoms: enlarged, tender ovaries, mild bloating and abdominal swelling, decreased appetite and nausea.
Moderate OHSS symptoms: enlarged, tender ovaries, more significant bloating and abdominal swelling, decreased appetite with nausea and vomiting, noticeable fluid retention in hands and legs/feet.
Severe OHSS symptoms: enlarged, tender ovaries, considerably worse bloating and abdominal swelling, nausea and vomiting, fluid retention in hands and legs/feet, significant weight gain (in excess of ten pounds), shortness of breath due to fluid accumulation in the abdominal cavity, reduced urine output.
Ultimately, some of these symptoms may present themselves after the egg retrieval procedure without the need for medical intervention because they self-correct on their own. However, an egg donor should work carefully with her treating physician and medical staff to discuss symptoms as they present.
What Are Some Precautions To Help Prevent Ovarian Hyperstimulation Syndrome?
While OHSS is a very real concern, medical practitioners take every precaution to prevent OHSS, with the most common methods for prevention as follows:
⇒ Devise the proper treatment plan tailored specifically to an egg donor’s baseline hormone levels and antral follicle count.
⇒ Require regular monitoring appointments to watch carefully for elevated estradiol levels.
⇒ For patients with high estradiol levels using a certain medication protocol, physicians may request an FSH “coast” for 1-3 days prior to trigger shot.
⇒ Trigger shot planning using Lupron, as compared to hCG. Because the half-life of Lupron is considerably less than hCG, OHSS symptoms are minimal and resolve very soon after egg retrieval.
⇒ Post-retrieval prescription medication, such as cabergoline, or post-retrieval use of Ganirelix injections.
⇒ Post-retrieval diet modification, including increased protein consumption and fluid type restrictions (high electrolyte drinks such as Gatorade).
Overall, OHSS is an unpleasant experience for egg donors. A medical practitioner’s goal through the duration of an egg donation cycle is to maintain a controlled ovarian hyperstimulation state, and to watch carefully for signs an egg donor might be at an increased risk for OHSS. OHSS is preventable by understanding risk factors, recognizing symptoms, and following a certain medication protocol planned in advance of the cycle (specifically, planning a Lupron trigger rather than an hCG trigger), or afterward (prescribing oral cabergoline or prescribing Ganirelix injections). An egg donor should work carefully with her medical team and discuss unusual symptoms as they develop.
Disclaimer: The content provided above is not intended for, nor should it be used as, a substitute for professional medical advice. It should not replace a conversation you have directly with your medical team. Prior to beginning an egg donation cycle, we strongly encourage you discuss the potential egg donation risks with your medical team, including ovarian hyperstimulation.