Ovarian hyperstimulation syndrome (OHSS), is a fairly rare, but potentially dangerous, side effect of ovulation induction. The ovaries can become enlarged, and fluid may start to build up in the abdomen and around the lungs. During IVF monitoring, it should be apparent if you are at risk of developing OHSS, and doctors can take action to prevent you getting ill. If you are producing far too many follicles and your oestrogen levels are very high, the cycle may be halted. Usually it can be treated by bed rest and drinking lots of fluids.
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The symptoms of OHSS include stomach ache, bloating, nausea and vomiting, breathing difficulties and faintness. If the condition develops, you would have to be admitted to hospital, as OHSS can be very serious, leading to thrombosis, heart attack, stroke or, in extreme cases, death. OHSS is more common among younger women and those who have polycystic ovarian syndrome.
'Nobody had really told me about the problems with hyperstimulation. They got 26 eggs and they were worried because my oestrogen levels were quite high. For a day or so I felt fine and then | kept being sick and I felt swollen. It just got progressively worse. My weight went up half a stone per day for about four days. They put a drain on my stomach because my abdomen was full of fluid, around my kidneys and liver. My legs filled up with water. We were both very frightened.' Elaine, 39
Immunological problems
Women who have had recurrent miscarriages are often offered tests to check whether they are producing too many antibodies, which may cause problems. Certain antibodies cause the blood to clot more easily, and this may lead to problems if the clots are in the blood vessels of the placenta. Around 15 per cent of women who have had repeated miscarriages have high levels of these anti-bodies, and they are usually offered low doses of either aspirin or heparin, or both, before conception and/or during early pregnancy.
Some doctors now believe that high levels of other antibodies could be a cause of infertility. They may offer testing and treatment for immunological problems to patients with fertility problems, in case raised antibodies could be preventing implantation or attacking an embryo. There are many different types of antibodies, and many types of tests, including one to look at levels of natural killer (NK) cells. There is still much scepticism about the true value of such tests, which are often expensive.
If testing suggests you may have immunological problems, there are a variety of treatments on offer, ranging from simple doses of aspirin or heparin to more complex therapies. You may be offered steroids, rheumatoid arthritis drugs or intravenous immunoglobulin G treatment (IVIg). It is important to be aware that these treatments are not licensed for use in reproductive medicine, that they are not scientifically proven, and that they may have side effects.
Such treatment can be very costly, and you will want to think carefully before signing up for it. For those who have had repeatedly unsuccessful IVF attempts, or recurrent miscarriages, it may seem worth trying, but you should discuss it carefully with your consultant first and make sure you are quite clear why you are being offered this treatment, what exactly it is meant to do, and that you are aware of any potential risks or side effects. There is no doubt that more research needs to be done in this area before such treatments can be widely recommended.
IVIg infusion treatment is usually given before and after egg collection, but it may also be offered to prevent miscarriage after a positive pregnancy test, although again there is no scientific proof that it can do this.
'My husband presented me with a pile of print-outs all saying this is unproven medicine, it is far too expensive and he said he thought it was a bit of a rip-off. But I'd had a positive pregnancy test, and I said I couldn't risk not doing it. The process was strange, to be with six or seven women for hours on end, all attached to drips. I only had one lot of IVIg and then when I went for my scan the following week there ws absolutely nothing there when they scanned me.' Debbie, 44. To find out more, you can check out What Is A Good Way To Get Pregnant.
