how do you avoid hyperstimulation?

[benderochka]

Hello
my close friend just had IVF done at the same clinic where i am going to do my iVF. At the beginning, things seemed ok but a week after ET, she hyperstimulated and was actualy hospitalized.
Does anyone know what needs to be done in order to avoid hyperstimulation? I am actually quite scared to go to that clinic now. My friend said that her abdomen is full of water and if the water is still there today they will remove it with invasive procedure.
Many thanks.
Veronica

[WindofSoul]

Hello Veronica,

from what I understand you avoid hyperstimulation by staying on stimulation meds that are not to high relative to you.

Like with me, with my first cycle (just done recently) my RE kept me on a relatively low dose of Follistim (around 200) cause he said he could tell my ovaries look very sensitive.

Plus make sure you discuss with your doc your concerns and worries about overstimming. I did, and he reassured me that my dose was safe and low enough.

hope that helps some...

[poppan]

I was at risk for hyperstimming because I have PCOS and produced a lot of follicles even though my meds weren't that high. It's a hard balancing act because if they don't stim you enough, your follies won't grow.

On cycle day 9 my RE started coasting me (no more stims, lupron only) because my largest follicles were at the desired size of 15-16mm which is when my clinic starts coasting. They monitored my E2 level daily so they would know when it either plateaued or dropped. When it dropped two days later, they told me to go ahead with the trigger shot.

During this time they also put me on fluid restriction. I could only drink 1 liter of water a day. To avoid dehydration they had me drink something with electrolytes in it (such as gatorade or propel or smartwater). This prevents fluid from going to the ovaries and making you start to swell.

We proceeded with the retrieval and I got a lot of eggs -- 27. 25 were mature and 21 fertilized. I had all the risk factors for OHSS (PCOS, young-ish, thin-ish, very high E2 -- 8,400 was my highest, a lot of follicles and a lot of eggs) so my RE advised me to freeze the embies and postpone the transfer. If we went ahead with the transfer that would have increased the risk of OHSS. Pregnancy also makes it worse. I am on fluid restriction for 10 days post-retrieval as a further prevention measure.

I did not get early onset OHSS but am still at risk for late onset OHSS. I'm feeling pretty good though so I think I will be fine.

I don't know what to tell you about that clinic -- it would make me think twice too. I know even with the best of care OHSS could still happen so I guess my question would be how they managed her care.

_____________________
Me: 31 DH: 34
Dx: Mild PCOS, auto-immune (NKCs 27%), MF (morphology)
TTC #1 2.5 years, never been pg
IVF #1 with ICSI, IVIg (for NKCs)
6/13 – 27 eggs retrieved, 21 fertilized, transfer postponed to August (NKs and E2 too high)
FET in August

[jcvp]

Well.... from my experience, I would try and do injections with IUI or injections alone before doing IVF. I didn't do either, and of course, I responded super well to injections - I was on follistim 150 and had severe OHSS - they took out about 25 eggs and I had 18 embryos frozen. Could not do the transfer b/c I started throwing up the night before the transfer - completely sucked! They had to drain around 2-3 liters of fluid out of me... Just did my first FET and BFN. I feel like I wasted my money on the IVF - I don't know why, but I just do. I do have 12 more embies left, so of course, we will try with those before going on...... If you test the injections first, then the dr will know what the right doses would be for you.

[missjess1975]

I hyperstimmed with an IUI (and am still on bedrest) the doctor explained that it is a risk and everyone gets a little hyperstimmed but they don't know how you are going to react to the hormones.
My case is moderate - not severe-(which sounds like what your friend had) and requires a week of bedrest.
Knowing what i know now I would really grill the doctor about how many people have hyperstimulated and what they do to prevent it.
At IUI I only had 3 mature follicles but had many that were under ten mm and the nurse said she wasn't suprised at all that I hyperstimulated (I wanted to say well if you aren't suprised then why did I?)
I only took have the trigger!
Anyway, I am partially venting and partially warning.

[jpper]

A good way to avoid hyperstimulation is do frequent monitoring by ultrasound and blood tests to make sure you're not developing too many follicles.

I hyperstimulated during my 1st IVF attempt using long protocol and about 300-something units of menopur+gonal-f combination: got 33 eggs, 22 mature, 17 fertilized. They only did one blood test on me to get a baseline and 2 ultrasounds. 1st ultrasound they saw 13 follicles. 2nd ultrasound saw 20. So they were "surprised" when 33 eggs were harvested.

Did not hyperstimulate the 2nd time: Dr. put me on a lower dose of just gonal-f and monitored more closely with 3 blood tests and 3 ultrasounds during the 10 day period of stimulation. Got 16 eggs, 15 mature, and 13 fertilized.

However, neither time has resulted in a pregnancy probably due to high # of chromosomal abnormalities, but that's a different topic thread!

[nyc76]

My clinic has me come in for daily monitoring the week before my scheduled ER. I assuming this is to avoid hyperstimulation and other things. It's a pain to come in every morning before work but definitely worth it for a healthy baby.