imposter_syndrome1 t1_iwwvej4 wrote on November 18, 2022 at 11:27 PM

Reply to comment by DrJosephDavisDO in I'm Dr Joseph Davis, Medical Director at Cayman Fertility Center. AMA about fertility, reproduction or IVF treatment. by DrJosephDavisDO

If the overstimulation happened during the egg retrieval cycle how do you suggest that not doing a fresh transfer is an option to prevent it? I had ohss already by the time of my egg retrieval, and my doctor told me (accurately to my experience and literature) that ohss symptoms peak in days 3-7 from the procedure. So while sure maybe the transition to fresh transfer would make it worse, surely that doesn’t actually have any prevention success for OHSS that has already begun. OP sounds like she’s doing a FET already anyway.

doingallthething t1_iwx3dng wrote on November 19, 2022 at 12:29 AM

You read my mind! It was the same for me. They were monitoring and were ready to freeze embryos and switch to an FET instead of fresh transfer, but I was already there... I know sometimes implantation can trigger symptoms to get worse, so maybe that's what he's implying??

DrJosephDavisDO OP t1_iwxobmf wrote on November 19, 2022 at 3:27 AM

Good follow up question! See my reply above but yes, hCG worsens OHSS. This is not only from an hCG trigger but also from a fresh transfer that implants and begins making hCG. This is the theory behind using agonist triggers and avoiding fresh transfers when OHSS is suspected.

Unfortunately not all OHSS can be avoided. We can just use certain approaches to lessen the duration of the OHSS and reduce the risk of worsening symptoms.

DrJosephDavisDO OP t1_iwxnynk wrote on November 19, 2022 at 3:23 AM

Great question. OHSS does get worse shortly after trigger especially with an hCG trigger (vs an agonist trigger). The symptoms peak as you rightly said 3-7 days after trigger. The benefit of freezing embryo rather than fresh transfer is the reduce the severity of the OHSS while it resolves. I typically use agonist triggers and plan to freeze if I see any risks or signs of OHSS. Even in the best of situations however OHSS can still happen. I believe the most important way to address OHSS is to have an open discussion about the signs and symptoms and make a plan with my patient about how to proceed. That being said, I do very few fresh transfers and have seen very few cases of severe OHSS since moving to that approach.