### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, My wife underwent IVF on 10th December 2009. ER( Egg Retrieval) was successful on that day .18 oocytes were recovered .but after two days pain started in her lower abdomin area and started increasing .The ART Specilist stopped the procedure of ET(Egg transplant) as ultrasound confirmed OHSS(Ovarian Hyper Stimulation Syndrom) .Ovaries size had increased (B/L Ovaries enlarged and cystic ( rt ovary - 8 cm, lt ovary - 7 cm, free fluid ++ve)) . She was hospitalised for 3 days.Specilist suggested Periodic Ultrasound . FET(Frozen Embryo Transplant) was planned after 2 months.After two montys no ET was done, as the thawed embryos were not of good quality as per the specialist (Embryos frozen : 4 (Grade 1A/2B)) . Medicine Suggested presentlly is Metformin- 1500mg, folic acid, colsprin - 75 mg. (These continued through out). Second cycle of IVF suggested from next day 21(started on 16 apr 2010 with Lupride 1/2 cc injections) . Some details: 1. Female Age : 31 2. Height : 173cm 3. Weight : 70 4. Reason of Infertility : PCOD (Polycystic Ovarian Disease), 5. Have you had any pelvic surgery? yes 6. Surgery Name : Adhesiolysis( Ovarian Drilling Done on both sides) (Year : 2006) 7. Findings : Both ovaries polycystic, fallopian tubes open 8. Medical problems and current medications of female partner: Suspected uterine Tuberculosis, had ATT (AKT - 2 / 4)medicines for 6 months. 9. In vitro fertilization (IVF) : yes Date : 10 Dec 2009 Stimulation Protocol : D21 onwards : Lupride 1/2 cc (14/11/09 to 8/12/09 (23 inj)), GonalF 225 ml (1/12/09 to 4/12/09 (4inj)), ChatDoctor ( 8/12/09 at 1 o clock at night) Dose of Hmg :300 Days of Hmg :D5,6,7 (5/12/09 to 7/12/09) Follicles grown :18-20 Eggs collected :15 (10/12/2009) Embryos formed :4 Embryos transferred :0 Embryos frozen :4 (Grade 1A/2B) My Question : 1. Is it possible that OHSS may reoccur 2. I want to reduce chances of OHSS. Please suggest how to go about it.

### output:

Hello there, thanks for writing in. I would like to discuss a few things with you.  HSS of severe degree is considered unacceptable these days with the introduction of antagonist protocol (agonist protocol as used in your case is more susceptible to develop HSS), especially in PCs women who are very prone to develop HSS. So next time when you undergo stimulation the choice should be an antagonist protocol which significantly reduces the chances of HSS.  Using metformin through ovarian stimulation will also bring down HSS risks.  Using GRH agonist as a trigger for final maturation of eggs in place of Chat Doctor will aid. At the same time the eggs can be frozen and transferred at a later date in FET.  Using lower dose and gradually increasing the dose to obtain a response (response is growth of multiple follicles) should be considered. Some physicians administer albumin infusion at the time of egg retrieval to prevent HSS. Hope the above provided information will assist you to discuss the strategies with your doctor regarding your concern. Take care.