This document discusses ovarian hyperstimulation syndrome (OHSS) based on data from 28 patients in Romania. It finds that most patients were not properly informed of OHSS risks prior to starting fertility treatments. Nearly half of patients reported not receiving adequate support from their clinics after developing OHSS symptoms. As a result, over 30% of patients who did not get pregnant decided to give up on further fertility treatments due to their traumatic OHSS experiences. The document concludes that while preventing OHSS is important, clinics must also ensure patients are well-informed of risks, can recognize symptoms early, and will receive support if OHSS develops.

1. OHSS: prevention can save lives
but also hope
Nicoleta CRISTEA-BRUNEL
Addressing the “extremes” in ovarian stimulation: new tools for poor & hyper responders
Bucharest, Romania, 12-13 December 2019

2. SOS Infertilitatea Association
• 11 years of activity
• Information, support, advocacy,
awareness
• Editor of the first fertility education
magazine in Romania
• Online community with over
16,000 members
13 December 2019 2OHSS: prevention can save lives but also hope

3. OHSS – patient perspective
0
2
4
6
8
10
12
14
16
25-30 Yrs 30-35 Yrs 35-40 Yrs
Numberofpatiens
Age group
• 28 patients
AMH
3.7 ng/mL 13 ng/mL
Antral follicle count
26 53
13 December 2019 3OHSS: prevention can save lives but also hope

4. OHSS risk
21
7
After stimulation
Moderate OHSS Severe OHSS
26
2
Before stimulation
PCOS No diagnosys
13 December 2019 4OHSS: prevention can save lives but also hope

5. OHSS reported symptoms
Estradiol after stimulation
5,120 pg/mL 9,412 pg/mL
Symptom Number of patients
Rapid weight gain All
Abdominal bloating All
Gastrointestinal symptoms
(nausea, vomiting, diarrhea)
All
Severe respiratory distress 2
Cardiac tamponade 1
Hemorrhagic ovarian cyst 2
One patient lost an ovary
13 December 2019 5OHSS: prevention can save lives but also hope

6. Pregnancy outcome
0
5
10
15
20
Fresh embryo
transfer
Freeze all
embryos
No embryos
Numberofpatients
Fresh
transfer
(19)
Positive
test (8)
Negative
test (11)
Evolution
stopped (2)
Evolutive
pregnancy
(6)
Frozen
embryos
(7)
No frozen
embryos
(12)
Freeze all
(5)
Evolutive
pregnancy
(3)
No
pregnancy
(2)
• All 9 patients with evolutive pregnancies were
under 33 yrs. old
• Only one of the patients with severe
hyperstimulation has obtained evolutive
pregnancy
13 December 2019 6OHSS: prevention can save lives but also hope

7. OHSS - awareness
Be
prepared!
Recognize
the
symptoms!
Be
informed!
24
4
OHSS awarness
Informed by self study/uninformed about the risks
Informed by the doctor about the risks
6 patients were informed about the OHSS risks only at
the end of the stimulation
11 patients did not receive support from doctor/clinic in
the first 24 hours after reporting the symptoms
3 patients received no support from the clinic after
OHSS triggered
13 December 2019 7OHSS: prevention can save lives but also hope

8. OHSS – impact on patients
• 9 patients (out of the 12 without pregnancy)
gave up on trying medically assisted
reproduction
– The OHSS experience greatly contributed to
the decision
• Negative psychological impact on both partners
(scared, concerned, fear of death)
13 December 2019 8OHSS: prevention can save lives but also hope

9. Conclusions
• Besides OHSS prevention there are other
important factors:
– The patient should be informed about the
risks before the procedure
– The patient should be able to recognize the
symptoms early
– The clinic should provide support for OHSS
patients
13 December 2019 9OHSS: prevention can save lives but also hope

10. 10
Thank you!