From the Guidelines
To prevent OHSS after egg retrieval, it is crucial to limit salt intake and increase protein consumption, as this approach helps manage fluid balance and maintain oncotic pressure in blood vessels. When considering the prevention of ovarian hyperstimulation syndrome (OHSS) after egg retrieval, dietary modifications play a significant role. The most recent and highest quality study 1 suggests a low salt diet, but in the context of OHSS prevention, the focus should be on balancing fluid intake and electrolytes rather than severely restricting salt. However, the key takeaway is to increase protein intake to 80-100 grams daily through lean meats, eggs, dairy, legumes, and protein supplements if needed, as this helps maintain oncotic pressure in blood vessels, keeping fluid in circulation rather than accumulating in tissues. Staying well-hydrated with water (2-3 liters daily) and electrolyte drinks is also important. These dietary modifications should be maintained for 1-2 weeks after egg retrieval or until OHSS symptoms resolve. If you experience severe bloating, rapid weight gain, severe abdominal pain, or difficulty breathing, seek immediate medical attention regardless of dietary measures. In the context of IUI and OHSS prevention, it's also important to note that withholding IUI when more than two dominant follicles >15 mm or more than five follicles >10 mm at the time of HCG injection or LH surge are present can help prevent high rates of multiple gestation pregnancies and OHSS 1. This approach, combined with appropriate dietary management, can significantly reduce the risk of OHSS and improve outcomes for individuals undergoing fertility treatments.
From the Research
OHSS Prevention and Egg Retrieval
- The use of GnRH antagonist has been shown to reduce the risk of ovarian hyperstimulation syndrome (OHSS) in patients undergoing egg retrieval 2, 3.
- GnRH antagonist can decrease VEGF production and function, which is a key factor in the development of OHSS 2, 4.
- Studies have demonstrated that GnRH antagonist rescue can result in excellent assisted reproduction outcomes, including high live-birth rates, in patients at risk for OHSS 5.
High Salt Protein and OHSS
- There is no direct evidence in the provided studies to suggest that high salt protein is a factor in the prevention of OHSS during egg retrieval.
- However, it is known that OHSS can cause electrolyte disturbances, including changes in sodium levels, which may be related to high salt intake 2, 6.
Egg Retrieval and OHSS Risk
- Egg retrieval can trigger OHSS in patients who are at high risk, especially those who have undergone controlled ovarian hyperstimulation (COH) with a GnRH antagonist protocol 6.
- The use of GnRH agonist triggering, instead of human chorionic gonadotropin (hCG) triggering, can reduce the risk of OHSS by shortening the duration of luteal stimulation and lowering estrogen levels 4.