Hi, friends, and welcome back to the As a Woman podcast. I'm your host, Dr. Natalie Crawford, and today is one of our favorite episodes. This is Fertility Q&A. Joining me is Emily Whitlock. Hello, Emily. Hi. And these are questions that you guys submitted. So you can go to Natalie Crawford,mdMD.comcom and you can look at the podcast section and submit your own

questions to be answered. Let's dive in. Okay, perfect. As a reminder, you have not seen these questions.

I have no idea what we're doing today. We're going rogue. I love it. Okay, the first one is short and sweet.

Tips to prevent OHSS. Great. So what is OHSS? Ovarian hypersimulation syndrome. This is a side effect or a complication of IVF. So if we remember in IVF, we're trying to get many eggs to grow. As we get multiple eggs to grow, each egg is making estrogen. And your estrogen levels are going to raise and we monitor these. Interestingly, even though I always talk about the female body

loves estrogen, too much of a good thing can be a problem. And estrogen levels that are this high,

they actually can destabilize the blood vessels is the easiest way to think about it. So if we

imagine a blood vessel and we think about inside is your blood and a lot of your blood is water,

when the blood vessels destabilize, the water component can move out, leaving the blood inside super thick, but that water has to go somewhere. So it goes on your abdomen, you get super bloated, and it can actually go in your lungs, and you can get what's called a pulmonary effusion. And that water can get infected, and then you can get doubly sick. Adding back, though, if the blood is

thick, you feel very dehydrated, your body's not getting what it needs. This can cause blood clots.

It can also cause kidney damage. So it's really a serious side effect of IVF that used to be a major

problem. So IVF technology has improved immensely and we really have reduced or almost mitigated

OHS from existing, especially for patients with PCOS who have a high egg count.

This used to be a big, big deal.

The number one thing to prevent OHSS is a protocol that is going to not use HCG as a trigger

shot.

Easiest way to think about this, HCG, which is the pregnancy

hormone, it binds the same receptor as LH. In a natural ovulation cycle, your body sends out LH,

which is super short acting, to allow the follicles to finalize their last stage of egg maturity.

Well, we don't have an isolated LH compound, interestingly,

so we can't give you LH. So we can give you HG, and this is going to bind to the same receptors,

but it lives so much longer in the body. The problem with that is it stimulates these cells to

keep making hormones for significantly longer period of time. So long story short is that you need

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