Ovarian hyperstimulation syndrome;
Should women with PCOS add acupuncture to an IVF program?
What is ovarian hyperstimulation syndrome (OHSS)?
Very simply, it’s an over-reaction. How very IVF.
In a natural non-medicated cycle, one follicle is selected to grow and will release an ovum (egg). During a medicated controlled ovarian hyperstimulation (COH) cycle, multiple follicles are activated to ideally produce a large number of eggs.
The crux is that OHSS is essentially an exaggerated response to your ovulation induction medication during your IVF cycle. Hows that for a mouthful?
Lots of eggs? Isn’t that a good thing?
It’s not that simple. Unfortunately, as with most overreactions - don’t I know it - there are consequences. While the mechanism of OHSS is still not entirely understood, the syndrome is characterised by problems like;
- Ovarian enlargement: While all women undergoing COH have some enlargement of the ovaries, with OHSS that increase in size is more pronounced and can cause nausea, vomiting and pain
- Fluid: If the follicles leak or rupture, follicular fluid can move into a third space and can have dangerous results.
- Low blood volume: Low blood volume carries the increased risk of blood clots
- Movement within the pelvis: organs within the pelvis can be pushed as the ovaries increase in size causing pain and possibly damage.
Who’s at risk?
Anyone doing a COH, but more likely women who
- Are using an hCG trigger shot
- Are younger
- Have a lower body weight
- Have a history of hyperstimulation
- Have polycystic ovaries - which brings us to this interesting systematic review and meta analysis…
Could acupuncture lower the risk of OHSS?
This 2017 study
suggests that yes, acupuncture may decrease the risk of OHSS in women with PCOS (diagnosed via the Rotterdam Criteria) who are undertaking IVF or ICSI.
This research included four studies, totalling 430 subfertile, child bearing age-women and found that those women undergoing an acupuncture protocol somewhere between 5 and 20 sessions long, had a lowered incidence of OHSS than those women who did not receive an acupuncture protocol.
Food for thought
As with all research, results need to be considered with a critical eye. 430 participants is still a reasonably small cohort, and there does not appear to be clear information regarding how the women were allocated into groups. There are no reports of adverse reactions from the acupuncture treatment – this doesn’t mean they didn’t happen, just that they possibly weren’t recorded.
My take – overall it’s an optimistic finding. OHSS at its worst is dangerous, and in mild cases can cause discomfort and result in postponed cycles while waiting for the symptoms to resolve. The protocols discussed in the meta analysis could certainly be considered for women undergoing IVF who do not necessarily have polycystic ovaries.
If you’re embarking on an IVF journey you can read
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