Ovarian Hyperstimulation Syndrome Korean 환자교육대학교생식관리 난소과자극증후군 증상및치료 이정보는일부수정을위한약을사용했을때나타날수있는상태인난소과자극증후군에대해설명합니다. 난소과자극증후군이란무엇인가? 난소과자극증후군 (OHSS) 이란일부수정을위한약의사용시나타날수있는상태를말합니다. OHSS의위험은에스트라디올의농도가매우높거나혹은 HCG 트리거주사 ( 이주사는난포의성숙과성숙한난자의배출을유발함 ) 를맞은다음다량의성숙한난포가존재할때증가합니다. HCG를사용하여배란유도를시행한여성들가운데최고 10퍼센트 (100명가운데 10명 ) 은 OHSS가어느정도발생합니다. 가장심하게영향을받은여성이라도그정도는경미내지중간입니다. OHSS 가심하게나타나는확률은 1퍼센트 (100명가운데 1명 ) 보다더적습니다. 클로미펜 ( 브랜드명 : 클로미드혹은세로펜 ) 또는난소배란을위해다른경구용약을사용한여성가운데 1퍼센트 (100명가운데 1명 ) 미만으로 OHSS가발생합니다. OHSS 는일시적인상태입니다. 1 내지 2 주면스스로없어집니다. 이러한이유때문에 OHSS 의치료는귀하의증상이호전될때까지귀하를편안하게해주는데주로중점을두게됩니다. OHSS 의원인은무엇인가? OHSS에대하여완전히알고있지는못합니다. 이배란을발생시킨 HCG 주사와이미높아진호르몬농도가합쳐져서발생했을수있습니다. 다수의작은난포를만드는여성들에게서 OHSS의발생확률이가장높습니다. HCG를맞게되면, 난소가커지고다량의호르몬과다른분비물이생성되며이로써혈관이 새는 현상이발생합니다. 혈액으로부터의액체가복부와흉부로새게됩니다. 동시에혈액내의액체가감소하여혈액의농도는높아집니다. 이것은신장의문제와전해질의불균형그리고혈전발생위험의증가를초래할수있습니다.
2 페이지대학교생식관리난소과자극증후군 OHSS 의증상은무엇인가? 경미내지중간정도의 OHSS 경미내지중간정도가 OHSS 에서가장흔한첫째증상들 : 복부팽만 복부불쾌감 체중증가 ( 최대 10 ~ 15 파운드의액체무게 ) 메스꺼움 변비 난소의크기증가 중증정도의 OHSS 혈액의농도가더증가함에따라서다음증상들이발생합니다 : 심한복통과팽만 메스꺼움과구토 배뇨의감소와짙은소변 서있을때의어지러움 숨가쁨 저혈압 낮고빠른맥박 복부나폐에물이참 전해질불균형 체중증가 (20 파운드이상 ) OHSS가중증인경우크기가커진난소가파열 ( 터짐 ) 되거나뒤틀릴확률이높아질수있습니다. 이것은통증을유발하며매우드물게는체내출혈을유발합니다. 이러한이유때문에, 저희는모든 IVF 환자들특히 OHSS가있는환자들이육체적활동을제한할것을권장합니다. 중증의 OHSS는드물지만, 발생하는경우즉시치료해야하는심각한질병입니다. 병원에서의추적진료방문이필요하며, 입원이필요할수있습니다. OHSS 어떻게예방하는가? 면밀한감시를통하여, 다음에의하여중증의 OHSS 대부분을피할수있습니다 : HCG 를사용하지않거나그용량을감소 배란의유도를위하여다른약을사용
3 페이지대학교생식관리난소과자극증후군 질문? 귀하의질문은중요합니다. 질문이나염려되는내용이있다면귀하의의사나 UWMC의료서비스제공자에게연락하십시오. University Reproductive Care: 웹사이트 : www.uwmedicine.org/ uwfertility 에스트로겐농도가낮아질때까지 HCG 를사용하지않음 이것을 코스팅 이라부름 OHSS 의위험이너무높을수있음을나타나는혈액과초음파정보가있을때는치료를취소시킴 모든배아를얼려서 OHSS 가해결되도록한다음배아를나중주기로이전시킴 며칠동안매일루프로라이드 ( 루프론 ) 을주사함 OHSS 위험을어떻게낮출수있는가? OHSS 의위험은임신한여성에게서더높습니다. 귀하에게 OHSS 의위험이있다고생각하면, 저희는 HCG 주사후다음을귀하에게요청할것입니다 : 게이토레이드와같은전해질이풍부한음료를 6 잔이상마신다. 주사후에는맹물을마시지마십시오. 매일아침먹거나마시기전에체중을잰다. 소변의색과양을체크한다. 팀에게귀하의체중과소변량을보고하여필요한 OHSS 관리에대해조언을받을수있도록한다. 언제클리닉에연락하는가 다음의경우클리닉에연락하십시오 : 하루에체중이 2 파운드이상증가한다 소변량이적거나소변색깔이검을때 다음의경우클리닉에즉시연락하십시오 : 메스꺼움이나구토 심한복통 저희는초음파와혈액검사가포함되는진료를위한방문을요청드릴것입니다. 귀하의증상이호전될때까지재검사와치료를매일해야할수있습니다. 클리닉이나병원에서수액의정맥주입 (IV) 을할수있습니다. 증상이중증이면, 복부의벽이나질을통하여액체를빼야할수도있습니다. 혈전의방지를위하여항응고제의복용을시작하는것이필요할수있습니다. Box 354692 4245 Roosevelt Way N.E. 3rd Floor, Women s Health Care Center Seattle, WA 98105 University of Washington Medical Center Ovarian Hyperstimulation Syndrome Korean Published: 08/2011, 11/2011 Clinician Review: 11/2011 Reprints on Health Online: http://healthonline.washington.edu
Patient Education Ovarian Hyperstimulation Syndrome Symptoms and treatments This handout explains ovarian hyperstimulation syndrome, a condition that can occur when some fertility medicines are used. What is ovarian hyperstimulation syndrome? Ovarian hyperstimulation syndrome (OHSS) is a condition that can occur when some fertility medicines are used. The risk of OHSS increases when levels of estradiol are very high, or when there are a lot of mature follicles after your HCG trigger shot (this shot causes follicles to mature and release mature eggs). Up to 10% of women (10 out of 100) who have ovulation induction with HCG develop some degree of OHSS. Most affected women have only a mild to moderate form. Severe OHSS occurs in fewer than 1% of women (1 out of 100). OHSS occurs in fewer than 1% of women (fewer than 1 out of 100) who have used clomiphene (brand names Clomid or Serophene) or other oral medicines to induce ovulation. OHSS is a temporary condition. It goes away on its own after 1 to 2 weeks. Because of this, treatment of OHSS focuses mainly on making you more comfortable until your symptoms improve. What causes OHSS? OHSS is not completely understood. It may be that hormone levels that are already high from ovarian stimulation, combined with the HCG shot that triggers ovulation, lead to it. Women who develop many small follicles are most likely to develop OHSS. After HCG is given, the ovaries become bigger and produce large amounts of hormones and other secretions that cause blood vessels to become leaky. Fluid from the bloodstream then leaks into the abdomen and chest. At the same time, the amount of fluid in the bloodstream decreases and the blood becomes more concentrated. This can cause kidney problems, electrolyte imbalance, and an increased risk of blood clots.
Page 2 Ovarian Hyperstimulation Syndrome What are the symptoms of OHSS? Mild to Moderate OHSS The most common first symptoms of mild to moderate OHSS are: Abdominal bloating Abdominal discomfort Weight gain (up to 10 to 15 pounds of fluid weight) Nausea Constipation Enlarged ovaries Severe OHSS As the blood becomes more concentrated, these symptoms occur: Severe abdominal pain and bloating Nausea and vomiting Decreased urination and dark urine Dizziness when standing up Shortness of breath Low blood pressure Rapid, shallow pulse Fluid buildup in the abdomen or lungs Electrolyte imbalances Weight gain (more than 20 pounds) In severe OHSS, the enlarged ovaries may be more likely to rupture (break open) or twist. This causes pain and, very rarely, internal bleeding. This is why we recommend that all IVF patients, but especially patients with OHSS, limit their physical activity. Severe OHSS is rare, but when it occurs it is a serious condition that must be treated right away. It requires many follow-up visits in the clinic, and it may require a hospital stay. How is OHSS prevented? With close monitoring, we can avoid most cases of severe OHSS by: Not giving HCG, or reducing the dose Using another medicine to trigger ovulation
Page 3 Ovarian Hyperstimulation Syndrome Questions? Your questions are important. Call your doctor or other UWMC health care provider if you have questions or concerns. University Reproductive Care: Website: www.uwmedicine.org/ uwfertility Not giving HCG until the estrogen levels fall this is called coasting Canceling treatment when blood and ultrasound information suggest there may be too high a risk of OHSS Freezing all embryos to allow OHSS to resolve, and then transferring embryos in a later cycle Giving daily injections of leuprolide (Lupron) for several days How can I lower my risk of OHSS? The risk of OHSS is higher in women who achieve pregnancy. If we think that you might be at risk for OHSS, we will ask you to do these things after your HCG injection: Drink at least 6 glasses of an electrolyte-rich drink, such as Gatorade. Do not drink plain water after your injection. Weigh yourself each morning before eating or drinking anything. Check the color and amount of your urine. Report your weight and urine output to your University Reproductive Care team daily so that we can advise you about OHSS management, if needed. When to Call the Clinic Call the clinic if: You are gaining more than 2 pounds a day Your amount of urine is low or your urine looks dark Call the clinic right away if you have: Nausea or vomiting Severe abdominal pain We will ask you to come in for an exam that includes ultrasound and blood tests. We may need to see you every day for retesting and treatment until your symptoms improve. You may be given intravenous (IV) fluid in the clinic or hospital. If your symptoms are severe, we may need to drain the fluid from your abdomen through your abdominal wall or vagina. You may also need to start taking a blood-thinning medicine to prevent a blood clot. Box 354692 4245 Roosevelt Way N.E. 3rd Floor, Women s Health Care Center Seattle, WA 98105 University of Washington Medical Center Published: 08/2011, 11/2011 Clinician Review: 11/2011 Reprints on Health Online: http://healthonline.washington.edu