{"id":1200,"date":"2020-01-29T13:54:56","date_gmt":"2020-01-29T13:54:56","guid":{"rendered":"https:\/\/staging.theduff.co.uk\/?p=1200"},"modified":"2021-07-27T14:14:58","modified_gmt":"2021-07-27T14:14:58","slug":"ovarian-hyperstimulation-syndrome-ohss-ivf","status":"publish","type":"post","link":"https:\/\/theduff.co.uk\/ovarian-hyperstimulation-syndrome-ohss-ivf\/","title":{"rendered":"<strong>Ovarian hyperstimulation syndrome (OHSS):<\/strong> how to deal with it"},"content":{"rendered":"\n<p><strong>OVARIAN HYPERSTIMULATION SYNDROME (OHSS) IS A NASTY, NASTY BEAST OF A MEDICAL CONDITION<\/strong> \u2013 one that could land you in hospital and significantly delay any planned fresh embryo transfers. <\/p>\n\n\n\n<p>(And while I don\u2019t want to freak you out for the hell of it, OHSS can kill you. So, you know, take it seriously.)<\/p>\n\n\n\n<p>Here's what you need to know: <\/p>\n\n\n<style>.elementor-572 .elementor-element.elementor-element-189190b1{padding:0% 36% 8% 22%;}.elementor-572 .elementor-element.elementor-element-6b407887 > .elementor-element-populated{margin:0% 3.2% 0% 14%;--e-column-margin-right:3.2%;--e-column-margin-left:14%;}.elementor-572 .elementor-element.elementor-element-65191d58{--box-background-color:#FCFAEE;--box-border-color:#007595;--box-border-width:0px;--box-border-radius:0px;--box-padding:24px;--box-min-height:48vh;--header-color:#F16653;--toggle-button-color:#333333;--item-text-color:#007595;--item-text-decoration:underline;--item-text-hover-decoration:underline;--marker-color:#007595;}.elementor-572 .elementor-element.elementor-element-65191d58 .elementor-toc__header, .elementor-572 .elementor-element.elementor-element-65191d58 .elementor-toc__header-title{font-size:20px;}.elementor-572 .elementor-element.elementor-element-65191d58 .elementor-toc__list-item{font-size:20px;}.elementor-572 .elementor-element.elementor-element-65191d58 > .elementor-widget-container{margin:0px 0px 0px 4px;}@media(max-width:1024px){.elementor-572 .elementor-element.elementor-element-189190b1{padding:0% 4% 10% 14%;}.elementor-572 .elementor-element.elementor-element-6b407887 > .elementor-element-populated{margin:0% 10% 0% 0%;--e-column-margin-right:10%;--e-column-margin-left:0%;padding:0px 0px 0px 0px;}}@media(max-width:767px){.elementor-572 .elementor-element.elementor-element-189190b1{margin-top:16%;margin-bottom:18%;padding:0% 0% 0% 0%;}.elementor-572 .elementor-element.elementor-element-6b407887 > .elementor-element-populated{margin:0% 0% 0% 0%;--e-column-margin-right:0%;--e-column-margin-left:0%;padding:0% 0% 0% 0%;}.elementor-572 .elementor-element.elementor-element-65191d58 > .elementor-widget-container{margin:0px 0px 0px 0px;padding:0px 0px 0px 0px;}}\/* Start custom CSS for table-of-contents, class: .elementor-element-65191d58 *\/.elementor-toc__header-title {\n    color: #333333;\n}\n\n.elementor-toc__list-wrapper {\n    margin: 0em 2em 2em 0em;\n}\n\n.elementor-toc__list-items--collapsible li:not(:last-of-type) {\n    margin: 1.5em 0em;\n    padding-bottom: 1.5em;\n    border-bottom: 0.5px solid #007595;\n}\n\n\/* --- For Mobile --- *\/\n@media only screen and (max-width: 400px) {\n    .elementor-toc__list-wrapper {\n    margin: -1em 0em 0em 0em;\n}\n\n.elementor-toc__list-items--collapsible li:not(:last-of-type) {\n    margin: 1.2em 0em;\n    padding-bottom: 1.2em;\n    border-bottom: 0.5px solid #007595;\n}\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"section\" data-elementor-id=\"572\" class=\"elementor elementor-572\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-189190b1 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"189190b1\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6b407887\" data-id=\"6b407887\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-65191d58 elementor-toc--minimized-on-none elementor-widget elementor-widget-table-of-contents\" data-id=\"65191d58\" data-element_type=\"widget\" data-settings=\"{&quot;exclude_headings_by_selector&quot;:[],&quot;collapse_subitems&quot;:&quot;yes&quot;,&quot;min_height&quot;:{&quot;unit&quot;:&quot;vh&quot;,&quot;size&quot;:48,&quot;sizes&quot;:[]},&quot;headings_by_tags&quot;:[&quot;h2&quot;],&quot;minimized_on&quot;:&quot;none&quot;,&quot;marker_view&quot;:&quot;bullets&quot;,&quot;icon&quot;:{&quot;value&quot;:&quot;fas fa-circle&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;minimize_box&quot;:&quot;yes&quot;,&quot;hierarchical_view&quot;:&quot;yes&quot;,&quot;min_height_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;min_height_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"table-of-contents.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-toc__header\">\n\t\t\t<h4 class=\"elementor-toc__header-title\">\n\t\t\t\tContents\t\t\t<\/h4>\n\t\t\t\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--expand\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__65191d58\" aria-expanded=\"true\" aria-label=\"Open table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-down\"><\/i><\/div>\n\t\t\t\t<div class=\"elementor-toc__toggle-button elementor-toc__toggle-button--collapse\" role=\"button\" tabindex=\"0\" aria-controls=\"elementor-toc__65191d58\" aria-expanded=\"true\" aria-label=\"Close table of contents\"><i aria-hidden=\"true\" class=\"fas fa-chevron-up\"><\/i><\/div>\n\t\t\t\t\t<\/div>\n\t\t<div id=\"elementor-toc__65191d58\" class=\"elementor-toc__body elementor-toc__list-items--collapsible\">\n\t\t\t<div class=\"elementor-toc__spinner-container\">\n\t\t\t\t<i class=\"elementor-toc__spinner eicon-animation-spin eicon-loading\" aria-hidden=\"true\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\n\n\n<h2 class=\"wp-block-heading\"><strong>What exactly <\/strong><strong><em>is <\/em><\/strong><strong>OHSS?<\/strong><\/h2>\n\n\n\n<p>It\u2019s a complication of fertility treatment \u2013 particularly IVF \u2013 that causes your ovaries to swell, fluid to build up around your tummy, and a nice bunch of accompanying symptoms. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What causes OHSS?<\/strong><\/h2>\n\n\n\n<p>Too many follicles, usually. When your ovaries are stimulated to produce follicles during IVF, there\u2019s a risk you\u2019ll produce \u201ctoo many\u201d follicles. If you\u2019re young, have PCOS or a low BMI, or a few other risk factors mentioned shortly, you\u2019re more likely to overstimulate and produce all those follicles.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"500\" height=\"373\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/too-many-follicles-e1583242758703.png\" alt=\"OHSS \u2013 caused by too many follicles\" class=\"wp-image-787\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/too-many-follicles-e1583242758703.png 500w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/too-many-follicles-e1583242758703-300x224.png 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How is OHSS caused by \u201ctoo many follicles\u201d? <\/strong><\/h2>\n\n\n\n<p>OK so this is bloomin\u2019 complicated and it appears that&nbsp;medical specialists still aren\u2019t entirely clear on what\u2019s going on, but here\u2019s the general gist: <\/p>\n\n\n\n<p>At the \u201covulation\u201d stage of every menstrual cycle, there\u2019s a hormone surge that causes the egg to break free from its follicle so that&nbsp;it can travel into the fallopian tube, ready to be fertilised. In a natural cycle, the hormone is LH; in an IVF-assisted cycle, the hormone is often hCG \u2013 which acts in very similar ways to LH. (If you want more detail about all this, read my mega-post about <a href=\"..\/ivf-step-by-step\/\">the entire IVF process<\/a>.)<\/p>\n\n\n\n<p>The hormone surge also acts as a signal to the ovaries to produce new and temporary capillaries. In a natural cycle, these capillaries invade the cells of your leftover ovarian follicle (the one that used to contain the egg), in order&nbsp;to deliver&nbsp;cholesterol to those cells. Why? Because then the cells can produce progesterone (which is made from cholesterol), which will help to sustain the lining of the uterus in case there\u2019s a pregnancy. <\/p>\n\n\n\n<p>These capillaries need to be made super quickly, and as a result, they wouldn\u2019t even pass the requirements of a corrupt building official in Turkmenistan: they\u2019re pretty&nbsp;darn leaky. The fluid portion of the blood leaks through the capillary wall, but it\u2019s not really a biggie when you only have one dominant follicle (as you would with a natural cycle): there won\u2019t be too many capillaries, and therefore there won\u2019t be too much leakage. What\u2019s more, the important stuff \u2013 the cellular portion of the blood \u2013 stays in the capillaries and does what it needs to do. <\/p>\n\n\n\n<p>See where I\u2019m going with this? <\/p>\n\n\n\n<p>When you have lots of follicles (caused by fertility treatment), you have lots of capillaries \u2013 and all the fluid from the blood leaks through the capillary walls. This time there\u2019s LOADS more fluid, and it all kind of swirls around in your abdomen with nowhere to go. The ensuing symptoms are a treat. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What are the symptoms of OHSS?<\/strong><\/h2>\n\n\n\n<p>There are three levels of seriousness: <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Mild (up to 33% of women who do IVF): <\/strong><\/h3>\n\n\n\n<ul><li>You have a mild build-up of fluid in your abdomen, which causes bloating\/swelling, abdominal discomfort, nausea, cramps and heartburn\/indigestion. <\/li><li>Your ovaries are enlarged\/\u201dstretched\u201d (usually by less than 8cm) in response to overstimulation, which causes more abdominal discomfort.<\/li><li>You experience mild weight gain caused by the fluid build-up (but less than 1 kg per day). <\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Moderate: <\/strong><\/h3>\n\n\n\n<ul><li>There\u2019s more of a build-up of fluid in your abdomen (called \u201cascites\u201d if the fluid exceeds a certain amount) compared to mild OHSS, and this produces even more pronounced bloating\/swelling, abdominal discomfort, heartburn\/indigestion, cramps and nausea\/vomiting. <\/li><li>Your stomach may be distended. <\/li><li>Your ovaries are enlarged\/\u201dstretched\u201d (8\u201312cm) in response to overstimulation, which causes more abdominal discomfort.<\/li><li>You experience weight gain caused by the fluid build-up (but less than 1 kg per day). <\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Severe to critical: (about 1% of women who do IVF): <\/strong><\/h3>\n\n\n\n<ul><li>You have so much fluid (\u201cascites\u201d) that it continues travelling up your body and ends up interfering with your diaphragm\u2019s ability to move \u2013 making breathing difficult. <\/li><li>The pressure from all the fluid makes your stomach feel incredibly&nbsp;bloated, \u201cfull\u201d and painful. <\/li><li>Your stomach will probably be distended. <\/li><li>Your blood volume decreases as a result of all the fluid leakage, which in turn&nbsp;might cause the kidneys to slow down their production of urine. Decreased urine output (defined as less than 30 ml of urine per hour) is considered a pretty&nbsp;serious symptom of OHSS. <\/li><li>Your blood viscosity increases as a result of the fluid portion leaking through the capillaries, leaving the cellular portion highly concentrated. This can put you at risk of blood clots in the veins and lungs (thrombosis). <\/li><li>Your ovaries stretch like crazy (more than 12cm) in response to the overstimulation, which brings about the same abdominal discomfort as moderate OHSS \u2013 but worse. <\/li><li>Very rarely, there might also be ovarian torsion \u2013 where the overstimulated ovary twists around itself, cutting off its blood supply. I felt ill just writing that sentence. <\/li><li>You get all the same crampy, bloating, heartburny symptoms as mild and moderate OHSS \u2013 but worse. <\/li><li>You feel weak and faint because of the reduction in circulating blood volume. <\/li><li>You experience significant weight gain caused by the fluid build-up (approximately 1 kg per day or more). <\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>When will the symptoms of OHSS appear?<\/strong><\/h2>\n\n\n\n<p>There are two time periods during which you can&nbsp;start to&nbsp;experience symptoms:<\/p>\n\n\n\n<ul><li>With \u201cearly onset OHSS\u201d, symptoms can appear within 24 hours of the hCG trigger, but it often takes anywhere up to nine days before they become really&nbsp;apparent.\n(Basically, don\u2019t do what I did \u2013 which was to wake up the day after 41 eggs were retrieved from my ovaries and smugly state, \u201c<em>If<\/em> I have OHSS, it\u2019s SO no big deal! All those women moaning on various message boards are <em>such <\/em>wusses.\u201d Two days later I was in hospital with a catheter in my urethra, a drip in my arm, and a tummy the circumference of an out-of-shape sumo wrestler.)\n<\/li><li>With \u201clate onset OHSS\u201d, symptoms appear after a successful fresh embryo transfer \u2013 which usually takes place up to ten days after egg retrieval (once your eggs have been mixed with sperm. It\u2019s a bit of&nbsp;a double-edged sword, this one: you\u2019re pregnant, but you also immediately <em>look <\/em>pregnant (and feel horrific) because you now have OHSS.\nThe reason you get late onset OHSS? Because after the hCG has justjustjust surged through your system thanks to the trigger injection, you get another hefty dose of the stuff \u2013 this time produced naturally by your body \u2013 when you become pregnant. If you had two embryos successfully transferred, you get to feel doubly elated and doubly shit. \n<\/li><\/ul>\n\n\n\n<p>If you get early onset OHSS, you\u2019re very&nbsp;likely to&nbsp;<em>also&nbsp;<\/em>get late onset OHSS \u2013 and late onset OHSS tends to be more severe and more longlasting (up to 12 weeks, at which point the body\u2019s natural hCG levels begin to&nbsp;die down). It\u2019s for this reason&nbsp;that&nbsp;you might be advised to freeze all your embryos and wait for your body to calm down before the embryo transfer.<\/p>\n\n\n\n<p>(If your doctors are aware from the start of treatment that&nbsp;you have a high risk of developing OHSS, you may be advised to do a frozen embryo transfer before they\u2019ve even done the egg retrieval. That\u2019s because you could, in theory, do the egg retrieval, feel absolutely&nbsp;fine, then proceed with a fresh embryo transfer without realising you were on the verge of some mothereffing OHSS symptoms.)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What type of people are likely to get OHSS?<\/strong><\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img decoding=\"async\" width=\"500\" height=\"429\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/young-low-bmi-e1583242913394.png\" alt=\"You're more at risk of getting OHSS if you're young, have a low BMI, and\/or you have a high ovarian reserve\" class=\"wp-image-791\"\/><\/figure><\/div>\n\n\n\n<p>Consider yourself more at risk if any of the following apply to you: &nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You\u2019re young (under the age of 35)<\/strong><\/h3>\n\n\n\n<p>This is possibly because you have a higher number of follicles remaining in your ovaries plus a greater density of hCG receptors. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You have a low BMI<\/strong><\/h3>\n\n\n\n<p>No one really knows why this is a factor.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You have a high ovarian reserve<\/strong><\/h3>\n\n\n\n<p>\u201cOvarian reserve\u201d has two separate components. The first is the actual number of follicles that&nbsp;you have in your ovaries. (Age has a big influence on your follicle count, but so does genetics, tobacco usage, and previous ovarian surgery.) <\/p>\n\n\n\n<p>The second is the actual health of the follicles and the eggs within them. Again, age is a biggie here: the younger you are, the more likely it is that you\u2019ll have high-quality eggs. <\/p>\n\n\n\n<p>A high ovarian reserve increases your chances of successful fertility treatment, but it also increases the likelihood that you\u2019ll get OHSS. <\/p>\n\n\n\n<p><a href=\"..\/egg-quality-quantity-ovarian-reserve\/\">Read more about age, egg quality and egg quantity here<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You have polycystic ovary syndrome (PCOS)<\/strong><\/h3>\n\n\n\n<p>You already have a larger number of follicles in your ovaries compared to the average person (although these follicles tend not to mature and ovulate properly), and you have a tendency to overrespond to certain hormones. These two things combined mean you have a greater chance of growing a large number of follicles. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You had a high level of anti-M\u00fcllerian hormone (AMH) before starting IVF treatment<\/strong><\/h3>\n\n\n\n<p>A high AMH level (determined with a blood test) is considered to be one of the best predictors of an OTT response to stimulation. High AMH is normally connected with PCOS and ovarian reserve. <a href=\"..\/amh-levels-ivf\/\">Read more about AMH levels here<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>You\u2019ve had OHSS before&#8230;<\/strong><\/h3>\n\n\n\n<p>\u2026 Or you overresponded to another type of fertility treatment (e.g. Ovulation Induction) \u2013 even if you didn\u2019t actually end up with OHSS itself. <\/p>\n\n\n\n<p>Remember, though: these are just risk factors, and anyone can succumb to the delights of OHSS. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Is OHSS preventable? <\/strong><\/h2>\n\n\n\n<p>Ish. Doctors can usually detect if you\u2019re likely to get it by looking at the following:&nbsp;<\/p>\n\n\n\n<ul><li><strong>Your risk factors before treatment<\/strong> (see above). <\/li><li><strong>Your <a href=\"..\/oestradiol-levels-ivf\/\">oestradiol levels<\/a><\/strong>&nbsp;(measured with frequent blood tests) while undergoing treatment. Oestradiol is a type of oestrogen, and having a sky-high amount of the stuff means you\u2019re at risk of OHSS.<\/li><li><strong>The number of follicles you\u2019re producing while undergoing treatment<\/strong>. Having lots and lots of large follicles is usually an indicator that your oestradiol levels will be elevated because each large (&gt;15mm) follicle will produce around 200\u2013500 pg\/ml of oestradiol. In an ideal world, IVF treatment will result in approximately 15\u201320 follicles (18\u201324mm), and oestradiol levels between 2,000 and 4,000 pg\/ml. Things get worrisome when you have more than 20 follicles (18\u201324mm), and oestradiol levels between 4,000 and 6,000 pg\/ml. Doctors do <em>not <\/em>like to see more than 30 follicles (18\u201324mm), and oestradiol levels above 6,000 pg\/ml.<br><br>It's also possible to have high oestradiol levels without a large number of follicles \u2013 and that's still an indication that you might get OHSS (although from what I can tell, doctors aren't completely sure why). <\/li><\/ul>\n\n\n\n<p>Once doctors have looked at all these things in conjunction with each other, they\u2019ll often be able to nip OHSS in the bud before it happens \u2013 or at least ensure you\u2019re not going to get a severe case of it. <\/p>\n\n\n\n<p>They have a few ways of doing this: <\/p>\n\n\n\n<ul><li><strong>Going short.<\/strong> If you clearly have a high risk of developing OHSS before beginning IVF treatment, you\u2019ll probably be put on the \u201cshort IVF protocol\u201d (rather than the \u201clong IVF protocol\u201d), because it involves drugs that reduce the risk of OHSS. This includes the drug used to trigger ovulation: instead of hCG, something called a \u201cGnRH agonist\u201d is used instead. (Read more about it in this post on <a href=\"..\/ivf-step-by-step\/\">the IVF process<\/a>.)<\/li><li><strong>Trigger happy(ish). <\/strong>If you were considered \u201clow risk\u201d (and therefore on the long protocol) but you start to show signs of developing OHSS anyway, your doctor may adjust down the amount of follicle-stimulating medication you\u2019re taking.\nThey may also decide to decrease how much hCG you take to trigger ovulation. (Some doctors believe that a reduction in hCG leads to reduced egg quality, but others think it does no harm whatsoever.)\nAnother option is to give you the same trigger injection that those on short protocols are given \u2013 but many doctors agree that this is usually ineffective among patients who\u2019ve been on the long protocol up to this point.\n<\/li><li><strong>Polycystic, polyshmistic.<\/strong> The use of \u201cinsulin-sensitising agents\u201d such as metformin has been shown to help prevent OHSS in women with PCOS.&nbsp;<\/li><li><strong>Aiming for a soft landing.<\/strong> If you rapidly develop high oestradiol levels (&gt;4,000 pg\/ml) combined with lots of follicles (more than 20), your doctor may tell you to stop taking your follicle-stimulating medication and wait a few days before taking the trigger injection. This is known as \u201ccoasting\u201d.<\/li><li><strong>The big freeze.<\/strong> If you\u2019re growing a large number of follicles but the doctors are confident they can stave off severe OHSS through some of the methods above, they might continue with the egg retrieval but tell you to freeze ALL embryos (rather than do a fresh embryo transfer a few days later). This is to prevent the \u201cdouble surge of hCG\u201d mentioned earlier. <\/li><li><strong>Abandon mission (sadface). <\/strong>If your body goes apeshit with tons of follicles, super-high oestradiol levels, and you\u2019re <em>already <\/em>feeling bloated and horrid, there\u2019s a chance you\u2019ll have to abandon the cycle and start again with a new IVF cycle. This is an ultimate last resort, though. <\/li><\/ul>\n\n\n\n<p>One or more of these methods should ensure you only end up with mild OHSS at the very worst. But, well, some people aren\u2019t so lucky. Take me: I was considered \u201chigh risk\u201d and \u2013 as predicted \u2013 my oestradiol levels went through the roof and I grew a ton of follicles. My doctors were prepared: I'd been told from the start that I\u2019d be freezing all embryos after egg retrieval, due to the fact that embryo transfer would worsen any (hopefully mild) OHSS symptoms that might appear. And when my oestradiol levels climbed to what they considered a dangerous level, I \u201ccoasted\u201d for a few days before having the GnRH agonist trigger injection.<\/p>\n\n\n\n<p>And yet I still ended up in hospital with moderate\/severe OHSS. Leaky capillary fluid collected all over my abdomen and higher up, making it hard to breathe. I gained 5 kg in five days. Eating was agony. I was up all night with stomach cramps. My waist size ballooned. My ovaries were ginormous (as seen on a scan). And oh goodness the <em>tightness<\/em>\u2026 no one had really told me about the tightness: it felt like my organs were going to burst out of my skin at any moment. It wasn\u2019t the best experience ever. <\/p>\n\n\n\n<p>(Gosh: that was the most typically British sentence <em>ever<\/em>. For any non-Brits reading this, what I mean is, \u201cIt was the goddamn <em>worst.<\/em>\u201d)<\/p>\n\n\n\n<p>This isn\u2019t to scare you or make you feel like any of the preventative measures above will do bugger all \u2013 just that you can never get rid of the risk completely.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img decoding=\"async\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x.png\" alt=\"\" class=\"wp-image-492\" width=\"229\" height=\"105\" srcset=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x.png 443w, https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/Group-1285@2x-300x137.png 300w\" sizes=\"(max-width: 229px) 100vw, 229px\" \/><\/figure><\/div>\n\n\n\n<p><\/p>\n\n\n<style>.elementor-291 .elementor-element.elementor-element-4c84a175{margin-top:2%;margin-bottom:12%;padding:1% 4% 1% 4%;z-index:2;}.elementor-291 .elementor-element.elementor-element-554afbfb > 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.elementor-widget-container{margin:6% 0% 2% 0%;padding:0px 0px 0px 0px;}.elementor-291 .elementor-element.elementor-element-39ffc0a2{font-size:1em;}.elementor-291 .elementor-element.elementor-element-68569f9a .elementor-field-group .elementor-field, .elementor-291 .elementor-element.elementor-element-68569f9a .elementor-field-subgroup label{font-size:1em;}.elementor-291 .elementor-element.elementor-element-68569f9a .elementor-button{font-size:0.8em;letter-spacing:0.2px;border-width:0px 60px 0px 60px;}.elementor-291 .elementor-element.elementor-element-68569f9a > .elementor-widget-container{margin:-4% 0% 10% 0%;padding:0px 0px 0px 0px;}.elementor-291 .elementor-element.elementor-element-4e68b04a{font-size:1em;}}\/* Start custom CSS for button, class: .elementor-element-144e6175 *\/#fdg {\n    color: #FFFFFF;\n}\n#fdg:hover {\n    color: #FFFFFF;\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"section\" data-elementor-id=\"291\" class=\"elementor elementor-291\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4c84a175 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4c84a175\" data-element_type=\"section\" id=\"Mailing-list-sign-up-box\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-554afbfb\" data-id=\"554afbfb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-21014cc2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"21014cc2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-7c412ba7\" data-id=\"7c412ba7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-144e6175 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"144e6175\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-size-sm\" role=\"button\" id=\"fdg\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">FREE DOWNLOAD<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ed2b9df elementor-widget elementor-widget-heading\" data-id=\"1ed2b9df\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Questions to ask your doctor at every stage of IVF treatment: free downloadable guide<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39ffc0a2 elementor-widget elementor-widget-text-editor\" data-id=\"39ffc0a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>IVF isn\u2019t just overwhelming<\/strong>; it can also be a mind-boggling and sometimes terrifying experience because there\u2019s so much to learn and so many rules to follow.<\/p><p>Problem is, doctors are busy \u2013 and they often don\u2019t have the time to anticipate your concerns and provide all the information you might need.<\/p><p>This downloadable guide contains questions that will help you understand the process better, get the answers you deserve, and feel more in control of the situation (and your rights as a patient).<\/p><p><strong>Enter your email address to receive it right away.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68569f9a elementor-mobile-button-align-center elementor-tablet-button-align-stretch elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"68569f9a\" data-element_type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;20&quot;,&quot;button_width_mobile&quot;:&quot;100&quot;,&quot;button_width_tablet&quot;:&quot;25&quot;,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"291\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"68569f9a\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"The Duff\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-80 elementor-md-75 elementor-sm-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Your email address\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-20 e-form__buttons elementor-md-25 elementor-sm-100\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-lg\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Get the PDF<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4e68b04a elementor-widget elementor-widget-text-editor\" data-id=\"4e68b04a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>I won't send you spam. Unsubscribe at any time.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\n\n\n<h2 class=\"wp-block-heading\"><strong>I have OHSS. How do I get rid of it?<\/strong><\/h2>\n\n\n\n<p>Unfortunately, despite taking all manner of precautions, you may still end up with OHSS. When it comes to how to treat it&#8230; there's both good and bad news. As is tradition, let's start with the bad. <\/p>\n\n\n\n<p>The bad news is that the answer is \u201cnothing\u201d. There\u2019s absolutely nothing you can do to &#8220;get rid of&#8221; or \u201ccure\u201d OHSS. The good news is that the condition is \u201cself-limited\u201d: it will run its course, which usually takes around two weeks. After the trigger injection, you\u2019ll have no reason to inject any <em>more <\/em>of the stuff, so you\u2019ll have no more hormone surges and the OHSS will clear up. <\/p>\n\n\n\n<p>That\u2019s not to say you won\u2019t need monitoring and\/or treatment, of course (especially for some of the worse symptoms, which could lead to severe medical problems of their own) \u2013 just that it\u2019ll definitely go away at some point soon. <\/p>\n\n\n\n<p>If you\u2019re pregnant and you have late onset OHSS, your symptoms too will be self-limited; it\u2019s just that it\u2019ll take a lot longer because it takes longer for the hCG to leave your system. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What kind of monitoring\/treatment might I need for OHSS? <\/strong><\/h2>\n\n\n\n<p>That depends on how badly you\u2019re suffering. Bizarrely, it also seems to depend on where in the world you live: doctors in the USA and UK seem to have very different opinions on how you should self-treat mild OHSS. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>For mild\/moderate OHSS\u2026<\/strong><\/h3>\n\n\n\n<p>Tell your clinic about your symptoms, as they may want to scan you in order to see just how large your ovaries are and how much fluid has collected in your abdomen. If they agree that your symptoms are mild\/moderate, you can probably self-treat at home (although you may still be monitored as an outpatient \u2013 especially if you plan on having a fresh embryo transfer). <\/p>\n\n\n\n<p>Self-treatment advice given by UK doctors (NHS and private) is usually as follows:<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"878\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/02\/About-to-OHSS-08-1024x878.png\" alt=\"How to treat mild OHSS\" class=\"wp-image-994\"\/><\/figure>\n\n\n\n<ul><li><strong>Make sure you\u2019re drinking enough water:<\/strong> your blood has lost a lot of fluid and is much more concentrated as a result, which makes your kidneys slow down (and can also cause dehydration). Water will help to rehydrate you and bring some fluid back into the blood. You ideally need to be drinking enough that you\u2019re peeing out pale yellow urine every two hours.<\/li><li><strong>Eat plenty of protein<\/strong>, which will help with the production of albumin \u2013 a component of blood that helps to keep the fluid part of the blood from leaking out of the capillaries. Some people also believe that protein makes the capillaries more substantial and inherently less leaky. <\/li><li><strong>Take paracetamol or codeine<\/strong> to manage the pain (although if you think your constipation was bad before the codeine\u2026). Don\u2019t take any NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or aspirin, because they can have a bad effect on your already-delicate kidneys. <\/li><li><strong>Avoid all strenuous activity<\/strong> to make sure you don\u2019t accidentally get your now-MASSIVE ovaries in a twist (quite literally). Many online sources specifically state that you should avoid sex, but they really needn\u2019t bother: OHSS is more mood-dampening than an early-morning call from your mother-in-law about her varicose veins. <\/li><li>On the other hand, don\u2019t just sit in bed for two weeks doing nothing but eat your weight in eggs and tuna: <strong>move around and do gentle walking <\/strong>to help avoid blood clots. <\/li><li>If you hadn\u2019t already been prescribed<strong> anti-coagulation\/blood-thinning drugs<\/strong> (known as low-molecular-weight heparin, or LMWH) in anticipation of OHSS, you might be told to start taking them now. Brand names include Fragmin, Clexane and Lovenox, and they\u2019re taken as injections. <\/li><li><strong>Weigh yourself <\/strong>at the same time every day to monitor for rapid weight gain (more than 1 kg per day). <\/li><li><strong>Monitor how often you\u2019re urinating<\/strong>, and what colour your urine is. <\/li><li><strong>Get yourself to a doctor (or hospital) if your weight is increasing significantly<\/strong> and you\u2019re not urinating anywhere near as often as normal. <\/li><\/ul>\n\n\n\n<p>If you find yourself on any American message boards or blogs, you\u2019ll likely find that the advice given to patients there differs in three main ways. Firstly, they\u2019re generally told NOT to drink pure water, but to have fluids containing electrolytes instead. (Gatorade gets mentioned a lot, and coconut water gets the nod from people who are freaked out by the sugar content and overall artificial-ingredientness of Gatorade.) That\u2019s because they provide sodium and potassium \u2013 which are being lost in the fluid from your blood leaking out of your capillaries. <\/p>\n\n\n\n<p>Secondly, American doctors encourage you to go crazy in general on your salt (and therefore sodium) intake. Apparently, this isn't just to address the electrolyte imbalance, but also due to reasons relating to osmosis: salt encourages the fluid out of your abdomen and into your bloodstream. <\/p>\n\n\n\n<p>Thirdly, many American doctors recommend that you take aspirin daily to help avoid blood clots. Aspirin is an NSAID \u2013 which British doctors specifically instruct you to avoid. So\u2026 yeah. <\/p>\n\n\n\n<p>I asked my NHS doctor about the American advice regarding fluids and salt (I hadn\u2019t heard about the aspirin thing at that point), and she looked both alarmed and angry. Heaven knows how she <em>hadn\u2019t <\/em>heard about this conflicting advice, but she didn\u2019t seem to think that a buttload of salt and sugary drinks would help in any way whatsoever.<\/p>\n\n\n\n<p>My opinion? OHSS will clear up when it will clear up. You can eat a Chinese takeaway with a side of salt \u2018n\u2019 vinegar crisps every night or plain chicken with rice, and it will still clear up in its own time. You can drink water or Gatorade\/Lucozade, and it will still clear up in its own time. Judging by the \u201cIt worked for me!\u201d comments from people on both sides of the Atlantic, it\u2019s all placebo. (Although please remember this is JUST my very cynical opinion.)<\/p>\n\n\n\n<p>When it comes to aspirin, though, check that one with your doctor. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>For moderate\/severe OHSS\u2026<\/strong><\/h3>\n\n\n\n<p>If you\u2019re doubled up in pain to the extent that you\u2019re thinking, \u201cThis has GOT to be worse than childbirth,\u201d if you\u2019re struggling to drink water because it makes you feel too sick, if you\u2019re putting on more than 1 kg per day, and\/or if you\u2019re struggling to breathe due to all the fluid flowing up through your body, you may well be admitted to hospital in order to be monitored more closely. <\/p>\n\n\n\n<p>Your condition is still \u201cself-limited\u201d, but doctors at the hospital can do a few things to hasten your recovery, make you feel more comfortable, and ensure some of the symptoms don\u2019t develop into bigger problems of their own: <\/p>\n\n\n\n<ul><li>If you can\u2019t drink fluids due to nausea, you may be given an intravenous drip (IV) instead. <\/li><li>Some patients are catheterised so that doctors can monitor fluid in vs fluid out (which helps them determine the seriousness of your dehydration and general condition). <\/li><li>If you\u2019re not urinating as much as you should be, and if the IV doesn\u2019t improve matters, you\u2019ll also be given an albumin solution to bulk up the blood (for the same purposes as eating protein \u2013 see above). &nbsp;&nbsp;<\/li><li>More hardcore pain relief medication will be available, such as pethidine. <\/li><li>You\u2019ll be given a pair of those super-sexy DVT socks to reduce the risk of blood clots. <\/li><li>\u2026 And you might also be prescribed anti-coagulation\/blood-thinning drugs (known as low-molecular-weight heparin, or LMWH) for the same reason \u2013 if you\u2019re not taking them already. There are a few different brand names, including Fragmin, Clexane and Lovenox, and they\u2019re taken as injections. <\/li><li>Your waist will be measured daily to check that the fluid in your abdomen is decreasing. <\/li><li>Very occasionally, the fluid in your abdomen will be drained off to make you feel more comfortable. It\u2019s called \u201cparacentesis\u201d, and it involves inserting a thin needle\/tube into your tummy under a local anaesthetic. It doesn\u2019t \u201ccure\u201d anything or prevent further build-up, but it\u2019ll make you feel better for a while. <\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Can I still do the embryo transfer if I have OHSS? <\/strong><\/h2>\n\n\n\n<p>Most doctors advise against it \u2013 and I would too, if you have anything worse than very&nbsp;mild OHSS. Give your body a chance to recover, and <em>then <\/em>do a frozen embryo transfer a couple of months later. (<a href=\"..\/fresh-embryo-transfer-vs-frozen-ivf-uk\/\">Success rates for frozen embryo transfers are on par with fresh ones these days<\/a>.)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>OHSS: all you need to know! <\/strong><\/h2>\n\n\n\n<p>The good, the bad and the ugly. <\/p>\n\n\n\n<p>\u201cThe good?\u201d you say. \u201cThe GOOD???\u201d Well, OK, this is a bit of&nbsp;a self-indulgent and thoroughly non-universal \u201cgood\u201d that I managed to eke out of the whole palaver: my husband ADORES hospital food, so it made me all kinds of happy to see him polish off my lukewarm chicken tikka masala and sponge pudding after he\u2019d spent the past few days worrying like hell about me. &nbsp;<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/theduff.co.uk\/wp-content\/uploads\/2020\/03\/chicken-curry-1024x576.jpg\" alt=\"Chicken tikka masala\" 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.elementor-widget-container{margin:6% 0% 2% 0%;padding:0px 0px 0px 0px;}.elementor-291 .elementor-element.elementor-element-39ffc0a2{font-size:1em;}.elementor-291 .elementor-element.elementor-element-68569f9a .elementor-field-group .elementor-field, .elementor-291 .elementor-element.elementor-element-68569f9a .elementor-field-subgroup label{font-size:1em;}.elementor-291 .elementor-element.elementor-element-68569f9a .elementor-button{font-size:0.8em;letter-spacing:0.2px;border-width:0px 60px 0px 60px;}.elementor-291 .elementor-element.elementor-element-68569f9a > .elementor-widget-container{margin:-4% 0% 10% 0%;padding:0px 0px 0px 0px;}.elementor-291 .elementor-element.elementor-element-4e68b04a{font-size:1em;}}\/* Start custom CSS for button, class: .elementor-element-144e6175 *\/#fdg {\n    color: #FFFFFF;\n}\n#fdg:hover {\n    color: #FFFFFF;\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"section\" data-elementor-id=\"291\" class=\"elementor elementor-291\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4c84a175 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4c84a175\" data-element_type=\"section\" id=\"Mailing-list-sign-up-box\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-554afbfb\" data-id=\"554afbfb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-21014cc2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"21014cc2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-7c412ba7\" data-id=\"7c412ba7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-144e6175 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"144e6175\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-size-sm\" role=\"button\" id=\"fdg\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">FREE DOWNLOAD<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ed2b9df elementor-widget elementor-widget-heading\" data-id=\"1ed2b9df\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Questions to ask your doctor at every stage of IVF treatment: free downloadable guide<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39ffc0a2 elementor-widget elementor-widget-text-editor\" data-id=\"39ffc0a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><strong>IVF isn\u2019t just overwhelming<\/strong>; it can also be a mind-boggling and sometimes terrifying experience because there\u2019s so much to learn and so many rules to follow.<\/p><p>Problem is, doctors are busy \u2013 and they often don\u2019t have the time to anticipate your concerns and provide all the information you might need.<\/p><p>This downloadable guide contains questions that will help you understand the process better, get the answers you deserve, and feel more in control of the situation (and your rights as a patient).<\/p><p><strong>Enter your email address to receive it right away.<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68569f9a elementor-mobile-button-align-center elementor-tablet-button-align-stretch elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"68569f9a\" data-element_type=\"widget\" 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