Managing OHSS risk

[SquishyBean]

I'm on my first IVF cycle and due for egg collection on Monday. We always knew I was high risk for OHSS as I have PCOS, and had an AMH of 205 initially, (which has reduced to 45 on Metformin), so were always planning to freeze the eggs from this cycle. My estrogen at day 5 of stims was around 3500 and despite starting on a low stim dose, I was told to reduce it further from day 6. I've just had my day 10 scan and bloods (blood results not in yet), and we're preparing for egg collection on Monday. Has anyone else had experience of having extra mitigating medication prescribed to help prevent OHSS? I wasn't expecting it and it wasn't in the original plan, but I've been prescribed Cabergoline for 8 days, to start at the same time as the trigger, and will have to start clexane (blood thinners) and ganirelix (gnrh agonist) injections following egg retrieval. Everything I've read seems to suggest these medications are used in moderate/severe cases of OHSS, and I hadn't heard of them being used preventatively like this, or of anyone, even high risk being prescribed them! It's making me feel quite nervous about what's to come, particularly as the Cabergoline has some pretty scary side effects associated with it! And it sounds like I'm extremely high risk if they're going to these lengths to mitigate the effects of the OHSS. Anyone had an experience like this?

[Chel91]

This kind of makes me cringe because I've been in your situation and then ended up with severe OHSS and hospitalised. I also have PCOS and a very high AMH (also being younger or slender are additional risk factors). Not to scare you, but I'd definitely follow the instructions and take whatever they tell you to because it can be really serious. Are they still going to trigger you with HCG? With those estradiol levels I'd ask for a non-hcg trigger. I did both, and the non-hcg trigger I actually had better results with too, and it reduces the chance of OHSS to nearly zero. Clinics need to catch up with this! My old clinic wasn't up to date sadly. If they are already prescribing you the medication then I'd feel reassured they are monitoring the situation, but if you don't feel well don't be afraid to call them or get seen. Best of luck xx

[SquishyBean]

Thanks for this reply! This actually makes me feel a lot better, as it's always been the plan to have a non HCG trigger, so hopefully that combined with the other drugs will keep me from getting it severely! I do also have the risk factors of being young and having a low BMI. The things we put ourselves through eh? 😂

[SquishyBean]

For anyone else interested in this topic, I found this study which showed the best outcomes in high risk patients treated prophylactically with gnrh antagonist trigger, Cabergoline and gnrh agonist post egg collection. Only 18% mild-moderate OHSS rates compared to 38% with just a gnrh agonist trigger and 29% with gnrh agonist trigger and Cabergoline. No cases of severe illness in any of the groups. pubmed.ncbi.nlm.nih.gov/313....

[Eloquentia]

Hi! Sorry to hear about the risk of OHSS. PCOS here too with high AMH. They only changed my trigger in the last moment, which didn't prevent it, alas. From what I was told, the main risk of severe OHSS comes from having a successful transfer that round as the doubling HCG fuels it. I developed mild to moderate OHSS, it was pretty unpleasant but the advice I got from my clinic was to adopt a very high protein diet to help prevent and moderate it, i.e. a few protein shakes or yoghurts per day. Apparently the protein helps the body absorb the excess liquid that builds up. I also sports electrolyte drinks. A hot water bottle helped. It resolved pretty quickly as soon as my post IVF period came. Very best of luck, I hope you don't develop it!