Ovarian Hyperstimulation Syndrome (OHSS) is a complication that can arise from fertility treatments, most commonly those involving controlled ovarian stimulation, such as In Vitro Fertilization (IVF). The syndrome is characterized by the ovaries becoming swollen and painful due to an excessive response to stimulating medication. While OHSS symptoms range from mild to severe, the most common complaint is noticeable and uncomfortable abdominal bloating. This physical discomfort can significantly impact daily life, making it necessary to understand the underlying cause and how to implement effective relief strategies.
Why Bloating Occurs in OHSS
The bloating experienced in OHSS results from a fluid shift. This process begins when the ovaries, stimulated by fertility medications, release high levels of biochemical mediators. Vascular Endothelial Growth Factor (VEGF) is considered the primary mediator, often stimulated by human chorionic gonadotropin (hCG) used as a trigger shot. Elevated VEGF acts directly on blood vessels, increasing their permeability. This allows fluid and proteins to escape from the bloodstream into the extravascular space. The fluid then accumulates in the abdominal cavity, a condition termed ascites. This fluid accumulation causes the rapid weight gain, distention, and uncomfortable pressure that characterize OHSS bloating.
Dietary and Fluid Adjustments for Relief
Managing the fluid imbalances caused by OHSS requires careful adjustments to diet and hydration. Since fluid leaks out of the bloodstream, the goal is to draw it back into the vessels. Increasing protein consumption is effective because it raises plasma protein (albumin) levels in the blood. Adequate protein intake helps create an osmotic gradient that encourages the fluid to return to the circulatory system. Focusing on high-protein foods, such as eggs, lean meats, fish, and protein shakes, can be beneficial.
Fluid intake must be carefully managed to maintain hydration without overwhelming the body. Patients should prioritize electrolyte-rich fluids over plain water, such as sports drinks, broths, and electrolyte mixes, to replace lost salts and nutrients. The exact fluid recommendation requires guidance from a medical team, as vomiting or dehydration may necessitate increased intake, while fluid overload may require restriction. In cases of significant fluid retention, the medical team may advise a temporary restriction, sometimes to as low as one liter per day, to avoid exacerbating fluid buildup. Sodium intake is also a factor; some physicians advise salty foods to help retain fluid in the intravascular space, while others recommend a low-sodium diet, depending on the patient’s condition.
Positional and Activity Strategies for Comfort
Behavioral adjustments promote comfort and prevent complications during recovery. While rest is important, maintaining light physical activity, such as gentle walking, helps maintain circulation and lowers the risk of blood clots. Strenuous exercise, high-impact activities, and movements that could cause ovarian torsion must be avoided until the ovaries return to their normal size.
For physical comfort, wear non-restrictive, loose-fitting clothing to prevent pressure on the distended abdomen. Positional changes can offer relief; many patients find it comfortable to lie on their side or use pillows to support the abdomen while resting. Applying a heating pad may provide warmth and muscle relaxation, but avoid this if a fresh embryo transfer has recently occurred.
Self-monitoring is a practical strategy for tracking the condition’s progression at home. This involves daily tracking of body weight, as a rapid increase of more than two pounds in 24 hours signals worsening fluid accumulation. Patients should also measure their abdominal circumference at the same point each day to monitor for significant swelling.
When to Seek Immediate Medical Care
While most OHSS cases are mild and resolve with supportive home care, the condition can progress rapidly, requiring recognition of severe complications. Rapid weight gain, specifically more than two pounds (one kilogram) in a single day, warrants immediate medical contact, as this indicates a significant fluid shift.
Other severe symptoms requiring urgent attention include:
- Unrelenting or worsening abdominal pain not relieved by over-the-counter medication.
- A decrease in the frequency or volume of urination, or producing very dark urine, signaling possible dehydration or kidney impairment.
- Shortness of breath, difficulty breathing, or chest pain, which can indicate fluid accumulation in the chest cavity or a pulmonary embolism.
- Signs of potential blood clots, such as pain, swelling, or tenderness in the calf or leg.