Written by Pavitra Sampath |Updated : October 8, 2014 8:14 PM IST
Recently, there was news about a lady from Madhya Pradesh giving birth to 10 foetuses that were stillborn. A patient of IVF treatment, this lady was found to be suffering from a complication called Ovarian Hyperstimulation Syndrome (OHSS). We spoke to Dr Aniruddha Malpani, leading infertility specialist, about the syndrome and what could have gone wrong in this particular lady's case.
What is Ovarian Hyperstimulation Syndrome?
OHSS or Ovarian Hyperstimulation Syndrome is a well-known complication of infertility treatment. In order to treat infertile women, doctors super-ovulate them by giving them hormonal injections to help them grow lots of eggs. If this is not monitored properly, some women may end up developing Ovarian Hyperstimulation Syndrome.
Super-ovulated ovaries contain many follicles which are loaded with oestrogen. After ovulation, a huge amount of oestrogen-rich fluid is poured directly out of the enlarged and fragile ovaries into the abdominal cavity. This fluid also contains chemicals which then coat the lining of the abdominal cavity (called the peritoneum) and cause it to become very permeable (leaky). Fluid literally pours out of bloodstream into the peritoneal cavity because of the 'leakiness' of the abdominal cavity's lining. The ovaries balloon in size, the abdomen swells, and some women may get light-headed with relatively low blood pressure, or dizzy because of the decreased blood volume. Some patients may even need to be admitted into an intensive care unit for monitoring and observation, since this can be life-threatening.
Can this be blamed purely on IVF or infertility treatments on the whole ?
A high order or multiple pregnancies (10 foetuses, like in the case of the lady from Madhya Pradesh) suggests that the woman has received extremely poor quality medical treatment; and that the doctor taking care of her was negligent. There are 2 possibilities; either the doctor performed IVF and transferred 10 embryos - whereas good clinics only transfer 1-3 embryos. Or, he/she performed IUI (intrauterine insemination) after super-ovulation; and she grew a large number of follicles (each of which contains eggs).
Ideally, the doctor should cancel the cycle when he knows that something is wrong, rather than proceed with the treatment.
When a woman does undergo hyperstimulation, what can she do to ensure that she does not suffer from this complication?
Unfortunately, there is nothing a woman can do or not do to avoid this condition. OHSS is an iatrogenic complication (a disease caused due to medical treatment). That being said, the risk of developing OHSS in a good IVF clinic is very low. Good IVF doctors know how to manage the patient, and how to prevent OHSS. (Read: All your questions about IVF and surrogacy answered)
What can the treating physician do to avoid this complication?
The best way is to observe the progress of the patient. If the doctor observes that the patient has grown too many follicles on ultrasound scanning, he should cancel the cycle, rather than continue with the treatment.
What factors mitigate this complication ?
There are several things that can lead to this complication, but some biological and man-made factors can also lead to it. Some of them are:
1.PCOD: A patient who has PCOD is at a much higher risk of developing OHSS, because they over-respond to super-ovulation medication.
2.Poor monitoring of treatment: It is essential that the doctor closely monitor the patient. He/she should make sure that the woman is quickly diagnosed in case of any complications like OHSS arise.
3.Irresponsible use of powerful HMG injections (Human Menopausal Gonadotropin which is used to induce super-ovulation) by poorly trained doctors.
4.Lack of awareness: An untrained or insufficiently trained doctor can be dangerous in cases where such specialised care is required. People should be aware about which doctor they are going to and check their credentials before opting for the treatment.
Finally, Dr Malpani says, 'I think the case of the woman from Madhya Pradesh highlights the fact that while infertility treatment can be a boon for many infertile couples, it is a two-edged sword; and the treatment should be used wisely by expert and experienced doctors. Sadly, IVF training in India for post graduate gynaecologists is practically non-existent; and every gynaecologist today has started calling themselves an infertility specialist, without having the expertise to provide advanced infertility care. Hopefully, the new ICMR rules which regulate ART clinics will put a stop to this kind of malpractice.' (Read: Indian celebrities who opted for IVF)
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