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Dr. Andrew Rynne

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Suffering from polycystic ovaries. Had unsuccessful IUI's and going for IVF. Having 20 follicles and 15 are mature. Can take HCG in this cycle?

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Dr. Shanti Vennam

OBGYN

Practicing since :1989

Answered : 7399 Questions

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Posted on Sun, 17 Nov 2013 in Women's Health
Question: hi doctor,

I am suffering from polycystic ovaries and had my 3 unsuccessful IUI's and this cycle i am getting IVF done and getting stimulated.
i m on 11th day of my cycle and i have around 20 plus follicles and 15 of them are mature n my E2 was 2200 two days before ( it might be more now)

i am a bit worried as my doctor wants to give me HCG trigger and i m worried about OOHS.

Do u think its right to give me HCG in this cycle?

and if i take decapeptyl does the chance of pregnancy decrease?

please also let me know what are the side effects of OOHS?
doctor
Answered by Dr. Shanti Vennam 10 hours later
Brief Answer:
Trigger injection can increase the risk of OOHS.

Detailed Answer:
Hello,

Thanks for writing to us.

Firstly, allow me to write a little about ovarian hyper-stimulation syndrome or OOHS. The causes of this situation arise right from the medication given to induce ovulation to pregnancy achieved as a result of such treatment. FSH, LH, HMG and hCG injections can give rise to OHSS. This is observed as a triggering injection is given when multiple follicles are developed as a consequence to induction.

The symptoms of mild OHSS include nausea, vomiting, diarrhea, mild to moderate abdominal pain, tenderness in the ovarian region and increasing abdominal girth. Severe symptoms can be seen in 1-2% of cases and include severe pain, rapid weight gain, sever nausea and vomiting, tense abdomen, decreased urinary output, breathing difficulty etc. Though this condition is not life-threatening, medical attention is an immediate necessity.

Risk factors for developing OHSS include polycystic ovaries, low body weight, raised estradiol levels in the follicular phase, large number of follicles and migraine headache.

With this background, I feel that it is better to avoid trigger injection in this cycle and wait for ovulation to occur. If your doctor sees less chance of risk, and is sure to go for IVF in this cycle itself, then it may be given with close monitoring.

The upper limit of E2 during the follicular phase of the cycle is 220 pmol/L and in the pre-ovulatory peak it rises to 1500 pmol/L. If your E2 values are above this limit, it is a risk factor for OHSS.

Decapeptyl should not be taken now as it can inhibit ovulation and your chances of pregnancy thereby decrease.

Hope your query is clarified. Please feel free to contact for more information. I will be happy to help.

regards,
Shanti.V.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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