Ovarian Hyperstimulation Syndrome: Just How Safe Are Fertility Drugs?

An article recently published by the Washington Post is highlighting a few of the risks associated with fertility treatments that some doctors feel are de-emphasized by existing medical literature.

What is OHSS?

Ovarian hyperstimulation syndrome (OHSS) is a rare condition experienced by some women who undergo in vitro fertilization (IVF).

To understand it, though, it’s important to have at least some grasp on the physical demands of the procedure. Normally, women release an egg one at a time – but only a small number of these eggs are viable to one day become a baby. Most are slightly abnormal or defective in some way.

For scientists hoping to produce a “test tube baby,” though, it can be woefully inefficient to collect one egg at a time – especially when IVF treatments can go for between $15,000 and $30,000 a pop. So instead, physicians rely on fertility-stimulating medications that help a patient produce some 10 to 15 eggs in a single bout, hoping that at least one will be viable in producing a child.

That’s where OHSS can crop up. While the medication will ideally spur the release of some 10 to 15 eggs, in certain rare cases (existing literature varies on the prevalence – claiming figures from anywhere between .03% up to 5% of IVF cycles) many, many more can be released.

Logan Andreotta, an “ideal” IVF patient, was one such case. Just three days after beginning to take fertility drugs, her ovaries were over-crowded with up to 50 eggs. “I felt like my insides were going to bust out of my stomach,” she said, describing her experience.

OHSS can lead to a number of serious medical problems – even death in some cases. That’s because when the ovaries are overstimulated, the body produces an excess of fluid that can inhibit the proper function of a number of vital organs. In 2005, Temilola Akinbolagbe, a 33-year-old Londoner who’d just begun IVF treatment, collapsed at a bus stop. She had developed OHSS, and the excessive fluids her body was producing led to a blood clot forming in a her pelvis. That clot led to a heart attack, and the unfortunate young woman’s death.

Some Believe Risks Are Understated

The severity of the adverse reactions have some people questioning the “risk-free” stance taken by some physicians. Tracking the successes, or in some cases failures, of fertility drugs is especially difficult in some countries where no such data is collected – countries like the United States.

Despite the fact that OHSS is exceptionally rare, there seems to be little consensus as to just how rare. Alan Penzias for example, an associate professor at Harvard Medical School, claimed that “We’re at a time point when, if there were anything major, we would have seen it by now,” when referring to risks associated with IVF fertility drugs. Penzias also stated that hospitalizations linked to OHSS are exceptionally rare, especially today.

The Washington Post’s analysis of American emergency rooms, however, found that between 2006 and 2014 more than 9,000 women sought assistance for OHSS. That’s about 1,000 women a year. Certain European medical societies tell their patients that as many as one in every three IVF cycles trigger at least mild OHSS symptoms.

IFV is an immensely popular procedure that will be undertaken hundreds of thousands of times this year alone. Given the potentially significant risks associated with fertility drugs, it falls on lawmakers and researchers alike to establish better means of collecting data to ensure the well-being of these mothers.

The risk is certainly there – current science is simply unwilling or unable to evaluate just how much risk, though. Increased monitoring of women undergoing IVF treatments might be our only way to one day better understand OHSS or similar conditions.

Doctors will sometimes describe fertility drugs as “risk free.” Do you think this constitutes false advertising? How do our data collection methods impact our understanding of real world medicine? Share your thoughts with Patient Worthy!

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