IVF - Third Injection

Hello Hello :)

I did my third injection today without the ice. A bit painful but the pain only lasted 1 minute. So it was fine. We took the injection 30 minutes earlier since Hubby had a meeting in KL today, so he had to rush for his meeting.

I have no plans yet for today. A friend invited me to go out for lunch but I don't feel like driving to KL for lunch on Friday. Plus tonight, we are having dinner at my in laws. So I might just chill at home today and catch up on my reading.

Oh btw, last night I felt slight discomfort near my tummy area. Almost like constipation. Also a bit of headache. I asked the nurse today and she said that is common. I am a bit nervous of hyper ovarian syndrome since it normally affects younger women. Since I am still in my 20s, I need to be extra careful. Below are some of the useful information about the syndrome.

Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of induction of ovulation, as part of assisted conception techniques.

It may occur after stimulation of the ovaries into superovulation with drugs such as human chorionic gonadotrophin (hCG) and human menopausal gonadotrophin. It is rare with clomifene except in polycystic ovarian syndrome (PCOS).

Many women with OHSS will be seen by doctors unfamiliar with the condition. This is because assisted conception treatment frequently takes place outside hospitals and also because serious OHSS is uncommon. Education and good communication are particularly important in providing safe and effective care to women with OHSS.


Epidemiology
Despite careful monitoring, a mild degree of ovarian hyperstimulation syndrome (OHSS) occurs in 33% of in vitro fertilisation (IVF) cycles.
A moderate degree occurs in as many as 3-5% of treatment cycles.
It may be severe in 1 or 2% of IVF cycles.

Risk factors
Polycystic ovarian syndrome (PCOS) greatly increases the risk.
Younger women are at greater risk.
High oestrogen levels and a large number of follicles.
The use of hCG for luteal phase support.
Administration of gonadotrophin-releasing hormone (GnRH) agonist. GnRH antagonists can be used within the treatment cycle to suppress the production of gonadotrophins and, in doing so, they shorten the treatment cycle.

Presentation
The diagnosis of ovarian hyperstimulation syndrome (OHSS) is based on clinical criteria and therefore clinicians should be aware of the signs and symptoms:

Symptoms usually appear 4 or 5 days after harvesting of eggs.
There is abdominal pain and distension due to accumulation of fluid.
In 1 or 2% of cases with very enlarged ovaries, the patient is ill with severe pain, nausea and vomiting.
There may also be pleural effusions with fluid passing from the abdomen into the pleural cavity.
Extravasation of fluid can cause haemoconcentration and hypercoagulability with risk of thrombosis.
If a woman (who is undergoing IVF treatment) presents with severe bloating, nausea and vomiting, shortness of breath and reduced urine output, urgent assessment in hospital is required.

Investigations
Careful monitoring of the ovaries by ultrasound during treatment is mandatory. The rate of growth of follicles is measured and treatment is cut back if stimulation seems excessive.