Ovarian hyperstimulation syndrome (OHSS) was a major obstacle to entry into IVF. Women who are very sensitive to fertility medications pose a dilemma to safe ovarian stimulation. The goal is control hyperstimulation of the ovary to recruit an optimal number of eggs while avoiding discomfort that is related to ovarian swelling. Furthermore, transferring embryos while the ovary is swollen offers a suboptimal environment for implantation and increases the discomfort felt by the patient. In some cases the ovarian swelling can be so severe that fluids shift into the ovary and patients can retain fluid while actually being dehydrated in their vital organs. When this occurred the physician would have to withdraw at least 10 pounds of fluid from the patient’s abdomen to relieve the discomfort.
Fortunately, severe ovarian hyperstimulation is a problem that no longer occurs. Currently we can achieve optimal stimulation of the ovary to recruit enough eggs for a current and any future desired pregnancy without the complication of OHSS.
There are two advances in ART that have improved IVF safety. One is the use of Lupron trigger. This medication is much shorter acting than the previous medications that have been used to mature eggs. As a result of its short duration the patient’s menses arrives 10 days after the eggs are retrieved and the swelling of the ovary resolves. By inducing menses quickly, the body is not receptive to implantation on the same cycle where the eggs are retrieved. The uterine lining is built up after the menses in a controlled way to offer optimal synchrony between the eggs and uterus. At this point the ovaries have shrunken back to their normal pre-stimulation size.
In order to maintain the embryo at a stage where implantation can occur while waiting for the uterus to synchronize its development, the embryos have to be stored in the laboratory for two weeks. This is achieved efficiently through a rapid freezing process called vitrification. Vitrification allows the embryo to be stored with minimal risk of harm and high survival rates. The achievement of synchrony between the embryo and uterus while avoiding ovarian hyperstimulation syndrome is optimized by separating the cycles of egg production and embryo replacement. An additional benefit of this technology is that genetic information about the embryo (PGS) can be obtained while waiting for the uterus to reach its implantation phase.
IVF has optimized pregnancy outcomes while increasing patient comfort and safety.
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