It seems that the mechanism is clear and, at first glance, not so complicated. It seems, well, a woman can not conceive, will do IVF and that's all! In most cases, so it is. But, as in any matter, there is another side to the coin. Unfortunately, not very pleasant.
What is hyperstimulation with IVF?
It turns out that in some women drugs that are used to stimulate superovulation cause a hyperstimulation syndrome. Each woman in her own way tolerates this condition. There are very serious cases. Especially often they are registered in women with a diagnosis of "polycystic ovary syndrome" (PCOS). If a woman is diagnosed with PCOS, she needs a reduction in the dose of the drug.
Ovarian hyperstimulation syndrome is the most serious and very dangerous complication that can occur with in vitro fertilization. Developing hyperstimulation already at the stage of superovulation, but manifests, as a rule, a little later - after implantation of the embryo in the womb of the womb of the woman.
If a woman with ovarian hyperstimulation has a pregnancy as a result of IVF, the condition of the pregnant woman, due to physiological hormonal changes, is further aggravated. In some cases, the symptoms of hyperstimulation persist for 10 or even 12 weeks. By the way, it is established that the earlier hyperstimulation has proved itself, the more difficult it will be.
Who can have hyperstimulation with IVF?
Although hyperstimulation syndrome is a disease, which is caused by medical intervention, no doctor can fully respond to the patient with a hundred percent accuracy, whether she is threatened with hyperstimulation syndrome. Nevertheless, there are certain factors that can contribute to the development of ovarian hyperstimulation. Among them: the genetic predisposition of women under the age of 35 (blonde and not inclined to fatness), polycystic ovary syndrome, an increased amount of estradiol in the blood, allergic reactions, the use of a-GnRH for the purpose of superstimulation, support of the luteal phase with hCG drugs.
Symptoms of ovarian hyperstimulation with IVF
About the development of hyperstimulation may indicate several symptoms that depend on the severity of the disease.
A light degree: a small puffiness, an increase in the volume of the abdomen, a feeling of heaviness, pain, like with menstruation, frequent urination. The diameter of the ovaries increases to 5-10 cm.
Medium: nausea, vomiting, appetite disorder, diarrhea, bloating, weight gain. Ovaries increase to 8-12 cm.
Severe degree: shortness of breath, heart rhythm disturbances, high blood pressure, very strong increase in stomach volume. The ovaries become more than 12 cm in diameter. In some cases, they reach 20-25 cm in diameter.
Complications of ovarian hyperstimulation are ectopic pregnancy, rupture of ovarian cysts, torsion of the appendages of the uterus. Ovarian torsion can happen because enlarged ovaries become very mobile. Torsion leads to a violation of blood circulation followed by necrosis (the ovary dies). A woman with a twist feels a sharp pain, which does not subside, but, on the contrary, intensifies. In this case, the woman needs an urgent operation. If already irreversible processes have occurred, you have to remove the entire ovary or part of it.
The most common complication of ovarian hyperstimulation is ascites (accumulation of fluid in the abdomen) and hydrothorax (fluid accumulation in the chest). This happens because the fluid from the bloodstream is not excreted through the kidneys or with the breath, but sweat in the cavity. There are other complications: the formation of thrombi (up to thromboembolism), a violation of the liver and (or) kidneys.
Treatment of ovarian hyperstimulation with in vitro fertilization
Most doctors are familiar with this problem only in practice. Sometimes a doctor for all his practice never meets with such.
To date, the mechanism of development of hyperstimulation is unknown, so there is no specific specific treatment. The only sure way will be cured - to eliminate pregnancy. But this is hardly a sure way, because it was for the sake of pregnancy that extracorporeal fertilization was performed, which provoked the ovarian hyperstimulation syndrome. Therefore, in a hospital, all the actions are reduced to making it easier for a woman to stay pregnant.
With a mild form of hyperstimulation syndrome, no medication is used. The woman is prescribed peace and proper nutrition, which includes plenty of drink, a full and balanced diet. A woman should monitor the weight and daily amount of urine excreted.
In the case of middle and severe forms of ovarian hyperstimulation syndrome, home treatment will not work. A woman is put in a hospital. The hospital follows her breathing, the work of the cardiovascular system, liver, kidneys. Follow the electrolyte balance (stomach size, weight, diuresis,). For the treatment of OHSS use drugs that reduce the permeability of capillaries, as well as that are used to prevent thromboembolism.
In severe cases, with ruptured cysts and internal bleeding, a woman will undergo a puncture of the abdominal cavity and surgery.
After the last stage of IVF - transfer of embryos - it is necessary to carefully monitor the condition of a woman. She is prescribed a quiet and forbidden sex with her husband. Sometimes, after the transfer of embryos, a woman can develop an inflammatory process.
Any married couple who dreams about a child, but who faces various difficulties on the way to a dream, experiences a strong emotional tension. In case serious complications are observed, psychological stress is possible. Some women are afraid, for example, that the use of stimulant drugs will provoke ovarian cancer. But, in fact, studies have shown that there is no connection between the methods of such drugs and ovarian cancer (however, like other organs).