Ovaries and IVF

Ovaries after IVF

Some women after in vitro fertilization complain that their ovaries hurt, and IVF is to blame. One of the stages of the procedure is the stimulation of ovulation. Many women who decide on in vitro fertilization are interested in exactly how it goes, and what to do if the ovary hurts after IVF.

Preparation for IVF

Every month, a woman releases one egg in her ovary. To achieve the maturation of several germ cells in one cycle, ovulation stimulation is used. It involves the appointment of hormonal drugs.

Before stimulation as part of IVF, a woman undergoes a number of specific studies.

These include:

• Gynecological examination.
• Laboratory tests for hormones, infections, blood clotting.
• Ultrasound of the pelvic organs and mammary glands (or mammography).
• ECG and fluorography.
• Smears for flora and oncocytology.
• Blood test for the presence of antibodies to sexual infections, HIV, hepatitis B, C and others.

All these examinations are carried out in order to check the ovaries before IVF and other organs. In a satisfactory condition, women are prescribed hormonal drugs to stimulate ovulation.

Stimulation procedure

To activate the function of the ovaries, a variety of medications are used. In different patients, the choice of drugs can vary significantly. The choice of stimulation scheme depends on the initial state of the body, ovarian reserve, the age of the woman, and the level of hormones.

The scheme for administering drugs to stimulate ovulation is called a protocol. They are different, but the short protocol is most often used. Sometimes IVF is carried out in a natural cycle, without superovulation stimulation.

Follicle puncture

After the maturation of several follicles and the subsequent administration of hCG, oocyte aspiration is performed. This procedure is invasive, but does not pose a danger to the woman's health.

It is carried out in several stages:

1. A woman is being prepared for manipulation.
2. The anesthesiologist performs the procedure of general anesthesia - medication sleep.
3. Under ultrasound guidance, a special thin needle is inserted through the vagina and brought to the ovary.
4. Using this needle and vacuum, the contents of each follicle along with oocytes are aspirated into test tubes.

The whole procedure takes 10-15 minutes. It is usually performed under intravenous anesthesia. Many women are afraid of pain in the ovary after IVF, which may occur as a result of the puncture. In fact, the pain is minimal, short-lived and easily stopped with painkillers.

Condition of the ovaries after puncture

At the end of the aspiration of the eggs, the woman remains under the supervision of a doctor for some time. She may experience general weakness, scant spotting, and a slight pain syndrome.

With severe discomfort, analgesics and antispasmodics are prescribed. Normally, these symptoms disappear within 24 hours. In the event of an increase in symptoms, which happens extremely rarely, it is worth consulting a doctor.

Ovaries after IVF

Immediately after aspiration of oocytes, they are subject to either fertilization or cryopreservation for further use in the next IVF cycles.

Despite the safety of the procedure, complications are sometimes observed. Very rarely, women may complain that their ovaries hurt during IVF. The most likely cause of this condition is ovarian hyperstimulation syndrome. It occurs as a result of an increased reaction of the body to the introduction of hormonal drugs. At the site of each punctured follicle, a small luteal cyst is formed, which can also give a slight pain syndrome.

In the case of hyperstimulation syndrome after IVF, the ovaries are enlarged, pain in the lower abdomen may occur. Dizziness appears, the general condition worsens.

To prevent the development of this complication, VitroClinic doctors always select the most suitable protocol for each particular woman. If the risk of hyperstimulation is assessed as increased, sparing stimulation schemes are preferred.

The ovaries after IVF during pregnancy, with its normal course, return to normal functioning. Cyst formation may occur with hyperstimulation, but this is rare, and such cysts spontaneously disappear after a few months. For the normal course of pregnancy, hormonal drugs may be additionally prescribed.

Ovaries after failed IVF

A fairly common myth that women who decide on IVF are afraid of is ovarian depletion. IVF is considered in this case as a procedure that makes the body work “for wear and tear”. Therefore, women worry that in case of unsuccessful fertilization, they will no longer be able to become pregnant in the future, because they will run out of eggs.

It's a delusion. Every woman has her own ovarian reserve, which decreases with age. When stimulated, those antral ovarian follicles grow, which under normal conditions would still atrophy and die. This is how the reproductive system in the ovaries works: one follicle becomes dominant, the rest undergo atrophy, and new ones grow in the next cycle.

During the stimulation of ovulation, several oocytes (7-10) mature at once, which allows you to immediately get more cells. Initially, each woman lays about 300 thousand eggs. By the age of 30, they remain on average 13%, by the age of 40 - 3%, and this is about 10 thousand potential oocytes.

In each individual case, an individual examination of the patient is carried out to select the best and most safe stimulation protocol.

IVF after ovarian resection

In practice, many cases have been described when IVF was performed with one ovary. A well-chosen protocol and proper preparation of a woman for ART make it possible to become pregnant even if there is only one ovary. In a young woman, even one ovary contains quite a lot of eggs.

But after 40 years and older, IVF with donor oocytes may be required. To understand what is the chance of getting your own high-quality eggs after ovulation stimulation, they check the ovarian reserve. To do this, determine the level of certain hormones in the blood (AMH, FSH) and do an ultrasound of the ovaries to count the antral follicles.

Maria Sokolova

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According to statistics, the effectiveness of the IVF procedure in our country (after the first attempt) does not exceed 50 percent. No one guarantees 100% success - neither in our nor in foreign clinics. But this is not a reason to despair: an unsuccessful attempt is not a sentence! The main thing is to believe in yourself, understand the essence of the problem and act correctly in the future. What are the main reasons for IVF failures, and what to do next?

The main reasons for unsuccessful IVF

Unfortunately, IVF failure is a reality for many women. Only 30-50 percent are diagnosed with pregnancy, and this percentage is significantly reduced in the presence of any diseases. The most common reasons for a failed procedure are:

• Poor quality embryos. For a successful procedure, embryos of 6-8 cells with high division rates are most suitable. In case of failure related to the quality of the embryos, you should think about finding a new clinic with more qualified embryologists. In case of failure associated with the male factor, it makes sense to look for a more qualified andrologist.

• Pathology of the endometrium. IVF success is most likely with an endometrial size of 7-14 mm at the time of embryo transfer. One of the main pathologies of the endometrium that prevents success is chronic endometritis. It is detected by echography. As well as hyperplasia, polyps, thinness of the endometrium, etc.
• Pathology of the uterine tubes. The possibility of pregnancy disappears in the presence of fluid in the fallopian tubes. Such anomalies require treatment.
• Problems of a genetic nature.
• Similarity of father and mother in terms of HLA antigens.
• The presence in the female body of antibodies that prevent pregnancy.
• Problems of the endocrine system and hormonal disorders.
• age factor.
• Bad habits.
• Obesity.
• Illiterate recommendations or non-compliance by a woman with the recommendations of a doctor.
• Poorly conducted examination (uncomposed immunograms, hemostasiograms).
• Polycystic ovary syndrome (poor egg quality).
• Decreased follicular reserve. Causes - depletion of the ovaries, the inflammatory process, the consequences of the operation, etc.
• The presence of chronic diseases of the female reproductive system, liver and kidneys, lungs, gastrointestinal tract, etc.
• The presence of infectious diseases (herpes, hepatitis C, etc.).
• Health disorders during the IVF procedure (flu, SARS, asthma or trauma, cholelithiasis, etc.). That is, any disease that requires the involvement of the body's forces to fight it.
• Adhesive processes in the small pelvis (circulatory disorders, sacto- and hydrosalpinx, etc.).
• External genital endometriosis.
• Congenital and acquired anomalies - a bicornuate or saddle uterus, its doubling, fibroids, etc.

As well as other factors.

Restoration of menstruation

The reaction of the female body to IVF is always individual. The restoration of menstruation usually occurs on time, although the delay is not a force majeure after such a procedure. The reasons for the delay can be, both in the characteristics of the organism itself, and in the general state of health. It is worth noting that self-administration of hormones during a delay after IVF is not recommended - it will provoke a delay in menstruation after taking the hormones themselves. What else needs to be remembered?

• Abundant periods are possible after IVF. This phenomenon does not indicate serious problems, there is no reason to panic. Periods can also be painful, longer, and clotted. Given the fact of ovulation stimulation, these changes are within the normal range.
• The next menstruation should return to the usual parameters.
• With deviations in the parameters of the 2nd menstruation after IVF, it makes sense to see the doctor who kept the protocol.
• Delayed periods after a failed IVF attempt (and other changes to it) do not reduce the chances of a successful subsequent attempt.

Can a natural pregnancy occur after an unsuccessful IVF attempt?

According to statistics, about 24 percent of parents who have experienced the failure of the first IVF attempt have conceived babies naturally after. Experts explain such a “spontaneous conception” by the “starting up” of the physiological hormonal cycle after IVF. That is, IVF becomes a trigger for turning on the natural mechanisms of the reproductive system.

What to do next after an unsuccessful IVF attempt - calm down and act according to the plan!

For pregnancy to occur after a failure with the 1st IVF attempt, many mothers decide to take drastic measures - not only to change the clinic, but also the country in which the clinic is chosen. Sometimes it really becomes a solution to the problem, because a qualified experienced doctor is half the battle. But most of the recommendations for women who are faced with unsuccessful IVF come down to a number of specific rules. So, What to do if IVF is not successful?

• We rest until the next protocol. This does not mean hibernation under a warm blanket at home (by the way, extra pounds are an obstacle to IVF), but light sports (walking, swimming, exercising, belly dancing and yoga, etc.). It is important to focus on exercises that improve the blood supply to the pelvic organs.
• We return to personal life "at will", and not according to the schedule. During the break, you can abandon the charts.
• We carry out a full examination, the necessary tests and all additional procedures to minimize the risk of repeated failure.
• We use all the possibilities for recovery (do not forget to consult a doctor): mud therapy and acupressure, hirudo- and reflexology, taking vitamins, etc.
• Coming out of depression. The most important thing, without which success is simply impossible, is the psychological mood of a woman. Unsuccessful IVF is not a collapse of hopes, but just another step on the way to the desired pregnancy. Stress and depression drastically reduce the chances of a successful second attempt, so it's important not to lose heart after a failure. The support of family, friends, spouse is extremely important now. Sometimes it makes sense to turn to professionals.

What should the doctor pay attention to after a failure?

• The quality of the endometrium and the embryos themselves.
• The level of preparation of the body for a possible pregnancy.
• The quality of the ovarian response to stimulation.
• The presence / absence of the fact of fertilization.
• Parameters of the structure/thickness of the endometrium at the time of transfer.
• The quality of embryo development in the laboratory.
• All possible reasons for the failure of the expected pregnancy.
• The presence of abnormalities in the development of the endometrium during the IVF procedure.
• The need for additional examination and / or treatment before the second procedure.
• The need to make changes to the previous treatment regimen before repeated IVF.
• Terms of repeated IVF (when possible).
• Making changes to the ovarian stimulation protocol.
• Changing the dosage of drugs that are responsible for superovulation.
• The need to use a donor egg.

When is a repeat procedure allowed?

A second attempt is allowed as early as the next month after the failure. It all depends on the desire of the woman and on the recommendations of the doctor. But most often a longer break is recommended for recuperation - about 2-3 months to restore the ovaries after stimulation and bring the body back to normal after stress, which is essentially IVF.

Analyzes and procedures shown after several unsuccessful attempts:

• Lupus anticoagulant.
• Karyotyping.
• Antibodies to hCG.
• Hysteroscopy, endometrial biopsy.
• HLA typing for a married couple.
• Serum blocking factor.
• Study of immune and interferon status.
• Blood test for antiphospholipid antibodies.
• Doppler study of the vascular bed of the genitals.
• Culture analysis to identify a possible causative agent of the inflammatory process.
• Examination of the uterus to determine the estimated parameters of the biophysical profile of the uterus.

In the presence of hidden inflammatory processes in the uterus (at risk - women after cleansing, abortion, childbirth, diagnostic curettage, etc.) treatments may include:

• Drug therapy (use of antibiotics).
• Physiotherapy.
• Laser therapy.
• Spa treatment.
• Methods of alternative medicine (including herbal medicine, hirudotherapy and homeopathy).

Re: Hyperstimulation and consequences?

And here are the consequences for me.
My hypera started at 6 dpo, but it was defined as the 1st degree, requiring neither hospitalization nor any special treatment. I went to the clinic 3 times with severe pain in my right ovary. But they always told me that it was enlarged, and there were multiple cysts, but since the clinical analysis of blood was in order, they let me go home.
Although the doctors promised me that by the 9th week my symptoms should have disappeared, and I should have felt better, at the 8 + 6 period my hyper reminded of itself like never before.
At 5 pm I was twisted so that I barely had the strength to call an ambulance, the phone was well next to the bed, but I had no idea how I would open the door, and the pain was so strong that I had to wait for my husband to return from work (40 minutes) there was no strength. The ambulance arrived 7 minutes after the call, so I did not think long, I had to get up. And then I had to...

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How to avoid ovarian hyperstimulation? This question is one of the most important at the IVF consultation. After all, this dangerous complication not only prevents the implantation of embryos, but also leads to such severe pathologies as torsion of the appendages, thrombosis, thromboembolism, rupture or necrosis of the ovaries. How to prevent the disease? And how to help the body in case of its development?

Ovarian hyperstimulation syndrome (OHSS) is considered an iatrogenic phenomenon, that is, a complication caused by medical intervention in the body. After his death in 1951, he has been under the scrutiny of doctors and scientists, as a certain degree of ovarian hyperstimulation is a necessary condition for successful IVF.

Features of the course of pathology

Under natural conditions at...

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ovarian hyperstimulation

In vitro fertilization is a lifeline for many couples who want to have children, but one of the most severe consequences of this procedure is ovarian hyperstimulation syndrome. This pathology is a response of the body to the introduction of a large number of hormonal drugs that are necessary to stimulate the ovaries.

The first symptoms of ovarian hyperstimulation appear in the early stages of pregnancy, that is, after the patient returned home after detecting positive dynamics. A sign of ovarian hyperstimulation is a feeling of discomfort in the lower abdomen, a feeling of heaviness and "bursting" due to a significant increase in the ovaries. Along with these changes, blood circulation is disturbed and fluid accumulates in the abdomen, which can be noticeable by an increase in the waist by 2-3 cm and a slight increase in weight. These signs characterize a mild form of ovarian hyperstimulation syndrome, which, like ...

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The emergence of a group of methods of assisted reproductive technologies in the 80s. The twentieth century gave millions of couples a chance to get a long-awaited pregnancy, including in cases where traditional medicine at that time remained powerless. The desire to increase the effectiveness of IVF treatment programs was associated with the need to obtain a larger number of good quality eggs during ovarian puncture, which naturally determined the use of more or less aggressive superovulation stimulation schemes.

Gynecologists-reproductologists faced a new condition at that time - ovarian hyperstimulation syndrome - a complication of IVF programs that introduces significant discomfort for patients into the treatment program and in some cases threatens their lives.

Time has passed, the active development of the methods of the embryological stage of the IVF program has made it possible with a sufficient degree of efficiency to obtain pregnancy in patients even from 1-2 eggs, the introduction of methods of cryopreservation of oocytes...

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Stimulation of the ovaries is one of the mandatory stages of in vitro fertilization. This procedure is a temporary restoration of ovulation with the help of drugs.

The purpose of ovarian stimulation is to generate more mature eggs, which are obtained by transvaginal puncture and fertilized in a specialized laboratory. This method of treatment is actively used in our clinic both independently and as part of IVF programs and is one of the most common methods of infertility treatment.

As a rule, after hormonal stimulation, several leading follicles mature in the ovaries, from which high-quality eggs can then be obtained. Doses of drugs for each patient are selected individually. Our specialists are always very careful in choosing the drug and its dose, because with inadequate stimulation of the follicles, various negative consequences may occur.

...

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Remember that IVF with own eggs or donor eggs can be diagnostic in and of themselves. Most couples will get pregnant on their first or second IVF attempt, which (obviously) suggests that IVF is all they need.

If implantation of embryos does not occur after 2 or 3 IVF cycles or occurs, but pregnancies fail early, then it is necessary to clarify the reasons for the failures before going through the protocol again. (we recommend that you read the article: “What is good in the IVF program”)

So, let's discuss the possible reasons step by step:

Make sure you have all the information available: You need to know:

What drugs did you take, at what dosage and for how long;

What was the condition of your ovaries (and uterus) just before you started your IVF cycle: how many antral follicles were on each ovary, what...

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Girls, on one site today there were heated discussions about "What I will never do with the next repair." The topic turned out to be so relevant and interesting that I decided to bring it up here. Let's share our mistakes and successes in repairing and furnishing our nests. I'll start with myself.

When you go pregnant for a long time, the whole world seems fabulous, and you are at least a fairy in it. Round such a fairy. Brilliant eyes, a mysterious smile, gait ... I will omit about gait. And you're waiting. And you think, eating the second ice cream on a park bench, HERE! More...

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Ovarian hyperstimulation syndrome is a pathological condition of the female reproductive system that occurs as a result of an inadequate response to hormonal drugs used during ART, or the wrong dosage of these drugs.

Ovarian hyperstimulation syndrome is expressed by a too strong response of a woman's ovaries to drugs that stimulate ovulation, as well as a complex of symptoms resulting from hormonal imbalance.

Based on the foregoing, the cause of ovarian hyperstimulation in IVF, as in other methods of infertility treatment, is the use of specific hormonal drugs that cause the development of an excess number of follicles, and as a result, the release of estrogen and progesterone in quantities exceeding the norm several times.

The cause of the development of ovarian hyperstimulation syndrome during IVF and other ART methods may be such provoking factors:

It should be noted that...

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ovarian hyperstimulation

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious and dangerous complications of the in vitro fertilization procedure. The main reason for its occurrence is the introduction of an excess amount of drugs to stimulate ovulation in the ovaries. Often, OHSS develops before embryo transfer into the uterine cavity, but it can manifest itself later - after implantation at the stage of their development.

Causes

Unfortunately, doctors cannot say with certainty whether ovarian hyperstimulation will occur in a particular patient. However, there are some factors that can contribute to the occurrence of ovarian hyperstimulation. These include:

Genetic predisposition of fair-haired young women under 35 years old, not inclined to be overweight; polycystic ovaries; increased activity of estradiol in the blood; the presence of confirmed allergic reactions; conducting a superovulation stimulation protocol using a-GnRH; ...

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I am from Belarus, so I don’t know how it is with you, we have a sick leave for a puncture and then no more than 21 days.

What to do .... throw all the bad things out of your head, tune in to the positive and go! Probably the most important thing in the protocol is to gain indifference (I understand that it is difficult, I myself am an impressionable fool) and calm down! If someone is unlucky, this does not mean that everyone will not be lucky: for example, I took an analysis for hCG on January 4, out of seven twos, only I was in flight, and the 6th was lucky! And you will be lucky!

I highly recommend drinking something soothing a couple of months before the protocol, at least a valerian pill at night (I just went to eco for the first time in September, I had problems at work, plus a year without a vacation, in short, fatigue and nerves all came together one to one, when they took me off the protocol (a polyp formed on the background of stimulation, I had to clean it.) - I was in hysterics, even more than now after the flight. But now I understand that sometimes you need to submit to fate a little and ...

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The reason for the development of ovarian hyperstimulation syndrome is the introduction of hormonal drugs that stimulate ovulation, which is used in the treatment of infertility and anovulatory cycles (menstrual cycles that are not accompanied by ovulation - the maturation and release of an egg from the ovary), during ART (assisted reproductive technologies), namely: IVF (in vitro fertilization), egg donation, ICSI (intracytoplasmic sperm injection), etc.
In response to this introduction, the ovaries begin to secrete estrogen and progesterone (female sex hormones) in quantities several times higher than normal.
At the same time: a large amount of biologically active substances are released, which dilate blood vessels and increase the permeability of the vascular wall for fluid; the liquid part of the blood from the blood vessels goes into the abdominal and chest cavities, into the pericardial cavity, into the tissues of the body, which leads to the development of ascites (accumulation of fluid in the abdominal cavity), ...

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Ovarian hyperstimulation is a response of the ovaries (their increase by 5-10, sometimes by 12-20 cm) to increased doses of hormonal drugs that are prescribed during IVF to increase the number of eggs that mature in one cycle.

As a result, the body begins to produce a large amount of estradiol, the blood thickens, blood vessels, capillaries become more permeable and the accumulated fluid is not removed from the body, but fills the tissues, causing them to swell.

Ovarian hyperstimulation syndrome is one of the most severe consequences of IVF,

which any infertile woman can face, especially with a long protocol, the presence of a genetic predisposition. Ovarian hyperstimulation syndrome can develop after pregnancy or even before the transfer of the embryos to the uterus. The sooner and more intensely its symptoms begin to appear, the more difficult the treatment will be.

Distinguish between mild and severe forms of ovarian hyperstimulation.

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Ovarian hyperstimulation: symptoms, consequences of OHSS after puncture and pregnancy

Ovarian hyperstimulation syndrome (OHSS) is one of the most formidable and unpleasant consequences of ovarian stimulation in the cycle. The existence of OHSS needs to be known to those who are only and those who have already had unsuccessful attempts, but repeated protocols are ahead. Any intervention in the body does not remain without consequences. But when the birth of a child is on the scales and, anyway, in most cases, the instinct to become a mother wins.

• What is ovarian hyperstimulation?
• Early and late OHSS
• Signs of hyperstimulation after puncture
• Effects
• How to avoid OHSS
• Who is at risk
• Symptoms of hyperstimulation
• What should be alarming
• Treatment

What is ovarian hyperstimulation

Ovarian hyperstimulation is a serious complication of ovarian stimulation, which is based on an uncontrolled response of the ovaries to the administration of gonadotropins (drugs that are administered to induce ovulation).

Without the presence of hCG, hyperstimulation will not develop. The hormone is a trigger in the appearance of symptoms and manifestations. Therefore, it is very important to monitor how the follicles grow, how many there are, and carefully choose the drug - - before. Drugs that are prescribed before the follicle puncture are prescribed for the "ripening" of the eggs. They contain human chorionic gonadotropin (hCG).

Ovarian hyperstimulation in IVF and pregnancy

If symptoms of hyperstimulation appear at the “after puncture” stage, it is recommended to postpone the transfer, and transfer it in a natural cycle or in). In the current situation, this is a good solution. A woman will endure mild hyperstimulation, the body will recover and the effectiveness of IVF protocols with cryopreservation is much higher - 65-70%, versus 30-35%.

Signs of hyperstimulation after ovarian puncture:

• temperature increase up to 38 °C;
• bloating;
• the appearance of edema, including ascites - the accumulation of fluid in the abdominal cavity;
• difficulty urinating;
• nausea and vomiting.

Consequences of hyperstimulation

The consequences of an excessive ovarian response to stimulation include:

• Ascites is the accumulation of fluid in the peritoneal space, hydrothorax is the accumulation of fluid in the pleural cavities. This complication occurs as a result of the launch of processes atypical for the physiological state, as a result of which blood plasma sweats through the mucous membranes and accumulates in the cavities.
• Torsion (complete and partial) of the ovaries is a rare consequence, but if it occurs, it requires surgical treatment.
• Gap.
• Follicular cysts.
• Renal failure.
• Liver failure.

How to avoid hyperstimulation during IVF

It is almost impossible to completely avoid OHSS during IVF. During in vitro fertilization, the actions of doctors and supervision are aimed at preventing the development of serious conditions. It is very important to notice the development of an uncontrolled reaction of the body in time and take measures to prevent severe forms of OHSS.

1. Identification of risk factors. For this, the hormonal background is controlled, much attention is paid to the hormone (). Ultrasound and folliculometry are performed already during stimulation.
2. Very mild stimulation schemes with low doses of drugs are used ().

The body of young girls with a good ovarian reserve, a normal level of AMH - can respond to a mild induction of ovulation by the growth of a large number of follicles. Hyperstimulation can also be prevented at this stage.

Prevention at the stage of ovarian stimulation:

• the choice of drugs for the maturation of eggs that do not contain hCG;
• delayed ovulation trigger:
• cancel ;
• use, if necessary, special preparations Dostinex or Cabergoline, low molecular weight heparins - Fraxiparin, Clexane.

Who is at risk for developing OHSS

Risk factors for the development of hyperstimulation are:

• young age;
• low body mass index (small, thin, slender girls);
• or ;
• high concentration of anti-Müllerian hormone (if the concentration is higher than 3.7 ng / ml, the higher the risk of developing an excessive ovarian response if stimulation is not carried out correctly);
• a large number of antral follicles, determined by ultrasound (more than 10 follicles from 4 to 10 in each ovary;
• history of hyperstimulation (in previous IVF attempts);
• aggravated allergic history.

Symptoms of ovarian hyperstimulation and classification

Mild manifestations of hyperstimulation occur in many patients of reproductive clinics.

Signs of ovarian hyperstimulation to watch out for

• Be sure to tell your doctor if there are such signs of hyperstimulation:
• weakness, dizziness, decreased blood pressure;
• shortness of breath, respiratory disorders;
• distension in the abdomen, bloating, pain in the hypochondrium and in the abdomen (diffuse);
• rare and scanty urination;
• increase in body temperature;
• swelling of the external genital organs and lower extremities.

What is hyperstimulation syndrome based on?

Attention! When examining for the presence of ovarian hyperstimulation syndrome, a gynecological examination is prohibited.

• blood pressure, respiratory rate, daily diuresis, abdominal circumference are measured
• Laboratory studies are carried out: a complete blood count with hematocrit (total protein, albumin, hepatic transaminases), hemostasiogram (D-dimer).
• Ultrasound of the small pelvis, abdominal cavity, pleural cavities.

Treatment of ovarian hyperstimulation

There is no pathogenetic treatment of ovarian hyperstimulation syndrome; all therapeutic measures are aimed at eliminating the symptoms of dysfunction of internal organs. Ovarian hyperstimulation is treated until the stabilization of clinical and laboratory parameters and the elimination of symptoms. Mild to moderate OHSS is treated on an outpatient basis, with severe OHSS requiring hospitalization.

For moderate hyperstimulation, the following simple corrective measures are necessary:

• Normalization of water metabolism - you need to drink up to 2 liters of fluid;
• A protein diet is prescribed. The goal is to limit foods that cause fermentation in the intestines and bloating. Vegetables, fruits, carbohydrates in large quantities are limited. Preference is given to protein foods: boiled chicken, fish, cottage cheese.
• To monitor the development of OHSS, body weight, abdominal circumference, and daily urine output are measured.

According to the indications, low molecular weight heparins are prescribed, under the control of D-dimer, and infusion therapy under the control of diuresis.

In severe hyperstimulation, antispasmodics may be prescribed. With severe and progressive ascites, laparocentesis is performed - a manipulation in which a puncture of the abdominal cavity is made and the accumulated fluid is removed. Surgical surgical treatment is carried out only in urgent cases in the presence of acute gynecological complications.

To avoid severe manifestations of ovarian hyperstimulation and the consequences, you must strictly follow your doctor's instructions and monitor your condition. In case of a sharp deterioration in well-being, it is necessary to contact the attending physician or the doctor on duty at the clinic where ovarian stimulation was performed.

Actual video

Symptoms and consequences of ovarian hyperstimulation

Ovarian function after IVF

Ovarian function after IVF

It is no secret that in most programs of in vitro fertilization and embryo transfer into the uterine cavity (IVF and ET), the method of stimulating superovulation is used. Stimulation of superovulation is necessary to compensate for the inevitable loss of embryological material at the stage before embryo transfer. In other words, the number of follicles obtained by stimulating superovulation almost never corresponds to the number of embryos suitable for transfer. Why? This is easily explained, taking into account the complexity of the processes of folliculogenesis:

• there may not be an egg in the follicle
• the ovum may not be suitable for fertilization
• the egg can be damaged during puncture, not fertilized, fertilized incorrectly
• the embryo may not develop properly

Thus, there can be a huge number of loss factors. It was in order to reduce these risks, increase the chances of, that superovulation stimulation was introduced - getting more follicles / eggs than would be possible in the natural cycle.

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Stimulation of ovarian function in the IVF cycle

Currently, many schemes have been developed for stimulating superovulation, however, by and large, the essence of this method is to increase the threshold of sensitivity to the follicle-stimulating hormone (FSH) of a larger number of follicles, which in the natural cycle would inevitably undergo reverse development (atresia). Thus, it is important to understand that the stimulation of superovulation affects the number of follicles that in this particular cycle would somehow be used up by the body and therefore superovulation stimulation does not deplete ovarian reserve.

Regardless of the chosen scheme for stimulating superovulation, an integral component of this technique is the actual stimulation of ovarian function. It can be carried out with both direct and indirect inductors. Most often, IVF programs use direct inducers of ovarian function - gonadotropin preparations (follicle-stimulating hormone - FSH, luteinizing hormone - LH). Depending on the specific clinical situation, both pure FSH and FSH in combination with LH can be used to stimulate superovulation.

The natural result of stimulation of superovulation is the growth and development of a certain number of follicles in the ovaries, which must contain eggs. The final stage of superovulation stimulation is the need to imitate the natural LH peak for the final maturation of eggs in the follicles (completion of meiosis). To imitate this peak, preparations of human chorionic gonadotropin (hCG), which have a structural similarity with LH, are usually used. 35-36 hours after the administration of the hCG drug, the follicles are punctured (the time when the eggs have already matured, but ovulation has not yet occurred). In the process of puncture of the follicles, a special needle is inserted into their cavity under the control of ultrasound (ultrasound) and the contents of the follicle are aspirated.

If the integrity of the follicle is violated by a needle, changes occur in it that correspond to the process of formation of the corpus luteum (luteinization) in the natural cycle, however, in the stimulated cycle, there are certain features of this luteinization, so the follicle after the puncture is usually called the theca-luteal cyst. The generally accepted point of view is that the alfalfa phase of the stimulated cycle is a priori inferior and requires correction with hormonal drugs. From the standpoint of ovarian function, the second half of the stimulated cycle is characterized by high levels of steroid hormones (estradiol, progesterone), which is only aggravated in the presence of ovarian hyperstimulation syndrome.

Ovarian function after IVF failure

In the event of pregnancy, ovarian function remains excessively active for several weeks, sometimes even months. And in the event that pregnancy has not occurred, the absence of the stimulating effect of hCG, or the abolition of hormonal support in the form of drugs, triggers a menstrual-like reaction in the body, with rejection of the endometrium, a sharp drop in the steroid-producing function of the ovaries, regression of theca-luteal cysts.

The period of ovarian rehabilitation after unsuccessful IVF is quite individual and is directly dependent on the number of follicles obtained and, as a result, theca-luteal cysts. That is, the more follicles were punctured, the more time will be needed for the complete regression of theca-luteal cysts in the ovaries. To manage the rehabilitation process and reduce the likelihood of various complications associated with ovarian hyperstimulation, hormonal contraceptives are usually prescribed. The use of this group of drugs causes a temporary, reversible blockade of the hypothalamic-pituitary-ovarian system, creating conditions for the "rest" of the reproductive system, necessary to restore its function.

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Questions for specialists

Eco Elena, 18.09.2019

Good afternoon! Please tell me, was a laparoscopy with the removal of the tube. How long does it take to recover to start an IVF protocol? And another question - can the husband donate sperm in advance, and use the frozen one for transfer in the protocol? Since there will be no opportunity to come to the transfer

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Empty follicles Irina, 09/18/2019

Good afternoon. 1 protocol-amg 1.67; 32 years; stimulation gonal 187.5 trigger diphereline 0.2: 7 oocytes received, 1 embryo on day 5. 2 protocol-amg 1.26; 34 years; stimulation pergoveris 150+gonal 75; trigger ovitrel 250: no oocytes. Stimulation didn't work or? Cause? What further encouragement?

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Medical services of inadequate quality Nadezhda, 09/16/2019

Hello, in another clinic they did cryotransfer, the doctor did not get acquainted with any fresh analysis made specifically for this transfer, only with 2 hormones, can this be regarded as a negligent attitude, did the doctor have the right to prescribe medications in support, without even knowing the results of the analysis blood, urine, etc. I plan to apply for a refund for the rendered service of inadequate quality

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Uterine fibroids in combination with adenomyosis Irina, 09/12/2019

Dear Maxim Stanislavovich! I would like to contact you with my problem. Now I am 30 years old, I have one baby 3 years old. For 10 years I have been observed by a gynecologist due to the presence of multiple fibroids in combination with adenomyosis. Nodes do not stand still, there is growth dynamics. I have been seeing one gynecologist for a long time, but I go additionally for consultations to others. All doctors, doing ultrasound, groan and gasp, what I have with my uterus at such a fairly young age. No one prescribed any treatment. They couldn’t get pregnant for a little over a year, they already wanted to stimulate the ovaries and send them to IVF, but it turned out to get pregnant on their own and carry it out without problems. After going to the doctor, who has been observing me and my body for a long time, she said that everything is bad, everything is growing, she is afraid of degeneration into a sarcoma and said that the uterus needs to be removed, the ovaries remain, everything is fine with them. But she sent me for a verdict consultation to a doctor who performs operations, she looked at the last ultrasound, looked at the chair, said everything is huge, it must be removed, but since I am quite young, it is always possible to remove and this is the last thing that can be done, she said, let's try to pierce 3 injections of luprid depot, there are cases that everything decreases significantly and you can postpone the operation for some period. Now the second child is not in the plans with her husband, if only later, but she said there are no deadlines in stock, either now after the injections, or never. In general, I was offered 2 options - to inject and see what happens next, or to lie down and remove the uterus with the cervix. The last ultrasound was on August 22, 2019, on the 7th day of menstruation, the size of the uterus: length 120mm, front-back. 119, width 120, uneven contours, heterogeneous structure, inter.subser along the front wall. m / y 36 × 30, in the bottom 52 × 30 mm, this is what can be measured by the device, so the entire uterus is dotted with small nodes, like grapes, endometrium 7 mm-1 phase, left ovary 34 × 15, no change, right 35 ×18, no change. Conclusion: multiple uterine fibroids in combination with adenomyosis. Prior to this, the previous ultrasound was done on April 6, 2019, the size of the uterus: length 98, front-back. 110, width 115, uneven contours, heterogeneous structure, dif., on the front wall inter. subser. m/y 38×32, side by side 35×31 mm, endometrium 12 mm, ovaries unchanged. Since April to August, the uterus has increased and now corresponds to 14 weeks of pregnancy, my doctor considers the only way out is removal. She also considers the injection of injections to be the only way out, but then to cancel the Mirena coil for 5 years and not touch the uterus. Other ninecologists don’t know what to do with me at all and speak directly, we are not able to help, you need specialists of a completely different level, I can hardly find such specialists in Gomel. An aspirate was taken from the uterine cavity on June 6, 2019, according to the results everything is fine, the diagnosis is fibroids in combination with adenomyosis, endometrial pathology. Closure: endometrium in the secretion phase, middle stage. Donated blood for tumor markers CA 125 -33, 11, HE 4 -81.53, ROMA premenopausal -21.31, ROMA postmenopausal - 27.87, PEA / CEA - 0.919. Hemoglobin 147, serum iron 21.7, ferritin 38.2. In addition to this, my gynecologist sent me to treat a cyst on the cervix, there was always an inflammatory type of smear, the cytology is normal, she said go treat, suppositories will not help, nothing will help, go to treat, you will come like a new penny with a good neck. I went for an additional charge and did a colposcopy, the doctor said a purulent cyst, it needs to be treated, it is like a pimple on the face with contents and it will not disappear anywhere. On April 8, for a fee, the professor performed a radio wave ablation of the cervix for me, two months later she came to this professor for an appointment, did a colposcopy, said everything was healed, live as you used to, and sent me home. I went again to another specialist for a colposcopy, she looked, said the wound had not yet healed at all, let it heal for another 2 months and not climb there. And the last doctor I visited, who operates and said to try injections for now, when examined on the chair, said that the cervix is ​​in poor condition, that there are foci of endometriosis on it and this is most likely after ablation. She even took a picture and showed how inflamed, red-burgundy she was, that's why she said that if you remove the uterus, I won’t leave you such a neck, it is in poor condition. And if you inject injections, then in 3 months, while I am pierced, I will treat the neck again, but not with the professor who did the ablation. They took an aspirate, because after this ablation I had bleeding on the 16th day of my period and before the next one, and so from month to month, although this had never happened before with all my problems. My gynecologist said that this was not related to ablation, it just happened, that your endometriosis is making itself felt, so in order to rule out something terrible, they took me an aspirate. And this doctor who does the operation said that it was the cervix with endometriosis foci that was bleeding. They say about EMA that I can’t do it, since my whole uterus is strewn with grapes, this is not my option. In such a situation. Sorry for such a long text. What is possible in my situation, tell me, please. Or there are no options, only the removal of the uterus with the cervix. But 30 years, somehow cruelly at all ... Our doctors have such an opinion, it bleeds, the cervix is ​​bad, the uterus is all dotted with knots, everything is growing, endometriosis, only to be removed with the help of abdominal surgery. To be honest, I don’t see the point in injections of luprid depot. What will happen to me after they are cancelled... I think about it. And is there a need to remove the uterus with the cervix in my situation? Thanks in advance!