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Suggest Ways To Prevent OHSS During Early Pregnancy
Question: My wife is 25 years of age and have pcos problem. We were taking treatment with a doctor who gave her 21 humog 75 injections for follicle stimulation. We were not informed about any possible side effects at all. My wife after few injections developed serious problems including short breathing tummy tightness urine infections. When we went to the doctor she said it is normal and asked us to come next week. But just after e days my wife's condition got worsened and i rushed her to our doctor and she asked me to admit her immediately to hospital as she has developed severe OHSS. 18 days we were in hospital including 7 days in ICU for observations. She had multiple organ dysfunction. The doctor never accepts her mistake and says that we are just unfortunate. My wife's blood test showed she was pregnant At arrival in hospital. We had to terminate it and we did it. I clearly see the negligency of doctor who at first never informed about any risks involved with hormone stimulation injections. Secondly my wife is just 25 year old and have pcos so she is at more risk then close monitoring was required which she didn't get. We lost everything and my wife is sischarged but still have pleural effusion and breathing problem which they say it would go gradually. Kindly tell me whether the doctor could have prevented this critical OHSS and is it that there is no doctor's fault and we are just unfortunate? After all OHSS is an iatrogenic complication and the doctor needs to be extra careful...
Brief Answer:
OHSS flares up with pregnancy
Detailed Answer:
Hi,
Good to see you back after long time. I adviced you about your semen analysis in the past.
It is unfortunate to see the complication your wife had to undergo. OHSS could have been identified earlier which could have prevented the complications.
Pregnancy flares up OHSS which happened in your case. It is an unfortunate incident that your wife had to suffer it and also lose pregnancy. It would not have been so severe if she were not pregnant. Pregnancy acts like adding fuel to fire. This turned out to be severe OHSS.
She is going to recover slowly. Give her high protein diet. She can still conceive in future. Don't try for pregnancy for next 6 months at least.
Let me know if you need anymore help.
Regards,
Dr. Mahesh Koregol.
OHSS flares up with pregnancy
Detailed Answer:
Hi,
Good to see you back after long time. I adviced you about your semen analysis in the past.
It is unfortunate to see the complication your wife had to undergo. OHSS could have been identified earlier which could have prevented the complications.
Pregnancy flares up OHSS which happened in your case. It is an unfortunate incident that your wife had to suffer it and also lose pregnancy. It would not have been so severe if she were not pregnant. Pregnancy acts like adding fuel to fire. This turned out to be severe OHSS.
She is going to recover slowly. Give her high protein diet. She can still conceive in future. Don't try for pregnancy for next 6 months at least.
Let me know if you need anymore help.
Regards,
Dr. Mahesh Koregol.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank u doctor. We will never go to any fertility clinic after this experience and we will not try for a child until atleast a year.. Can u please tell me is it not mandatory as per ICMR to inform and explain all possible risks and taking written consent before proceeding with hormone stimulation injections? It all happened as a shock to me and the doctor was not helpful at all. I had no money with me but due to her treatment my wife was critical and i had to pay 4.15 lakh hospital XXXXXXX Everyday more than 2 litres of fluid was removed from the paracentesis tapping for 12 days on the right side.now she has pain in the left side as there is still alot of fluid on the left side. The doctor did not help us financially even a little bit. She only says we are unfortunate.
Also my wife got her menses yesterday and her uterus is paining like hell. I am so helpless i cant do anything for her.. Please give me a detailed answer regarding these points doctor it would be of great help..
1) Cant i XXXXXXX the doctor for Medical negligence as she handled the case carelessly where pcos woman of 25 years of age was given that many humog 75 and humog 150 injections and no preventive measures were taken?
2) Is it not mandatory for ART clinics to follow guidelines of ICMR and take a written consent before giving hormone stimulation injections?
3)Cant late OHSS(OHSS occuring in early pregnancy be prevented)?
4) My wife after her menses has swollen tummy and severe uterus pain which is unbearable. Any medicine u can prescribe for releaf ??
Also my wife got her menses yesterday and her uterus is paining like hell. I am so helpless i cant do anything for her.. Please give me a detailed answer regarding these points doctor it would be of great help..
1) Cant i XXXXXXX the doctor for Medical negligence as she handled the case carelessly where pcos woman of 25 years of age was given that many humog 75 and humog 150 injections and no preventive measures were taken?
2) Is it not mandatory for ART clinics to follow guidelines of ICMR and take a written consent before giving hormone stimulation injections?
3)Cant late OHSS(OHSS occuring in early pregnancy be prevented)?
4) My wife after her menses has swollen tummy and severe uterus pain which is unbearable. Any medicine u can prescribe for releaf ??
Brief Answer:
Better to take medicines from a doctor directly
Detailed Answer:
Hi,
I know the pain you are going through. Let me explain the questions you asked:
1) This is a known complication and difficult to XXXXXXX as negligence. You are likely to loose the case and spend on lawyers again.
2) ICMR guidelines have not yet become law and hence are not yet mandatory.
3) Difficult to prevent late OHSS.
4) Since she is recovering from severe OHSS , it is better to take medicines from your doctor.
5) May I know the doctor and clinic and city who has given injections and severe OHSS resulted ? I will suggest another good doctor for you to follow up if I know in your city.
Better to take medicines from a doctor directly
Detailed Answer:
Hi,
I know the pain you are going through. Let me explain the questions you asked:
1) This is a known complication and difficult to XXXXXXX as negligence. You are likely to loose the case and spend on lawyers again.
2) ICMR guidelines have not yet become law and hence are not yet mandatory.
3) Difficult to prevent late OHSS.
4) Since she is recovering from severe OHSS , it is better to take medicines from your doctor.
5) May I know the doctor and clinic and city who has given injections and severe OHSS resulted ? I will suggest another good doctor for you to follow up if I know in your city.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The doctor's name is XXXXXXX GB ,Aspire fertility clinic , HSR Layout , XXXXXXX .
But this is grave injustice and someone has to take action. My present and future has been spoiled and my wife is half dead and living with lot of pain. What was the need to give such a high risk medication without taking my written consent after informing me if all possible risks involved is my question to her. I knew only 1 thing that IUI helps insemination directly to uterus through vagina so i did not question anything else. As a layman i did not know anything about this ovarian stimulation until my wife was critical and batrling for her life.. I will ask the court that as i did nit have money and because of some doctor's medication my wife was critical, what would the court advise me to? Leave my wife to die or go to govt hospital...
Thanks for your patient hearing dear doctor and yes please suggest me a good doctor in XXXXXXX to whom i can show all the reports and get an opinion....
Thank u.
But this is grave injustice and someone has to take action. My present and future has been spoiled and my wife is half dead and living with lot of pain. What was the need to give such a high risk medication without taking my written consent after informing me if all possible risks involved is my question to her. I knew only 1 thing that IUI helps insemination directly to uterus through vagina so i did not question anything else. As a layman i did not know anything about this ovarian stimulation until my wife was critical and batrling for her life.. I will ask the court that as i did nit have money and because of some doctor's medication my wife was critical, what would the court advise me to? Leave my wife to die or go to govt hospital...
Thanks for your patient hearing dear doctor and yes please suggest me a good doctor in XXXXXXX to whom i can show all the reports and get an opinion....
Thank u.
Brief Answer:
OHSS is a known complication
Detailed Answer:
Hi,
I saw the reports of ovulation induction you have attached.
1) Let me put across some facts about ovulation induction in PCOS and use of gonadotropins for ovarian stimulation to enhance your understanding of what could have happened.
Use of Gonadotropin ( GTN) injections ( HUMOG) for ovarian stimulation is a common practice in PCOS when there is no response to medication. Dose of GTN depends on response and further higher doses have also been used to have a resistant ovary to respond. There's no ceiling dose or duration for the use of these drugs. I see in tha attached reports that initially dose was started with only 75 IU and stepped up to 150 IU. This is called step up protocol which is used commonly by fertility specialists. Your doctor has used right method.
Taking consent before GTN is not mandatory at present and no law as such and not practised commonly. It's not mandatory in XXXXXXX as yet.
2) prediction of late OHSS ( with pregnancy) is difficult and cannot always be prevented especially so in IUI cycles. This is flared up by pregnancy and was dificult to diagnose at earlier stage.
3) OHSS is a completely reversible condition. Your wife seems to be on her path to recovery especially if she has started to menstrute. Possibly in another few days she will be completely up and about. It is likely that the pleural effusion you have mentioned would probably have reduced by now since menstruation heralds complete recovery.
4)Termination of pregnancy is one of the methods to control/reverse and hasten the recovery . Possibly hence it was advocated to you and carried out. Continuing pregnancy would have deteriorated her health further.
5) Please note that you went to the doctor for infertility treatment and your wife was treated for infertility late OHSS is one of the problems that can arise from and not exclusively from that treatment. Hence it cannot amount to medical negligence or malpractice. There is no use of filing case when it is a documented complication in medical literature.
6) Early OHSS can still be anticipated and monitored to some degree . From what you say it looks more like pregnancy which lead to the problem.
7) There have been cases where OHSS has been reported in natural cycles and use of tablets alone also.
8) Since the problem (here late OHSS) is anticipated as rare, the doctor need not explain the same to the patient.
9) uterine pain looks more like menstrual pain and will resolve completely after her cycle. After her pleural effusion resolves her breathing issues would also be completely gone.
What matters the most is the intention before any treatment and here use of injections was meant to cause ovulation and treat her problem that's infertility. So if the intention is correct any other argument may not stand valid in the court as OHSS is a known complication of these injections in few women.
Its good to know you are also in XXXXXXX If you wish, you can meet me at the following address with prior appointment:
Dr.Mahesh Koregol.
XXXXXXX XXXX
XXXXXXX
Let me know if I can be of more help.
Regards,
OHSS is a known complication
Detailed Answer:
Hi,
I saw the reports of ovulation induction you have attached.
1) Let me put across some facts about ovulation induction in PCOS and use of gonadotropins for ovarian stimulation to enhance your understanding of what could have happened.
Use of Gonadotropin ( GTN) injections ( HUMOG) for ovarian stimulation is a common practice in PCOS when there is no response to medication. Dose of GTN depends on response and further higher doses have also been used to have a resistant ovary to respond. There's no ceiling dose or duration for the use of these drugs. I see in tha attached reports that initially dose was started with only 75 IU and stepped up to 150 IU. This is called step up protocol which is used commonly by fertility specialists. Your doctor has used right method.
Taking consent before GTN is not mandatory at present and no law as such and not practised commonly. It's not mandatory in XXXXXXX as yet.
2) prediction of late OHSS ( with pregnancy) is difficult and cannot always be prevented especially so in IUI cycles. This is flared up by pregnancy and was dificult to diagnose at earlier stage.
3) OHSS is a completely reversible condition. Your wife seems to be on her path to recovery especially if she has started to menstrute. Possibly in another few days she will be completely up and about. It is likely that the pleural effusion you have mentioned would probably have reduced by now since menstruation heralds complete recovery.
4)Termination of pregnancy is one of the methods to control/reverse and hasten the recovery . Possibly hence it was advocated to you and carried out. Continuing pregnancy would have deteriorated her health further.
5) Please note that you went to the doctor for infertility treatment and your wife was treated for infertility late OHSS is one of the problems that can arise from and not exclusively from that treatment. Hence it cannot amount to medical negligence or malpractice. There is no use of filing case when it is a documented complication in medical literature.
6) Early OHSS can still be anticipated and monitored to some degree . From what you say it looks more like pregnancy which lead to the problem.
7) There have been cases where OHSS has been reported in natural cycles and use of tablets alone also.
8) Since the problem (here late OHSS) is anticipated as rare, the doctor need not explain the same to the patient.
9) uterine pain looks more like menstrual pain and will resolve completely after her cycle. After her pleural effusion resolves her breathing issues would also be completely gone.
What matters the most is the intention before any treatment and here use of injections was meant to cause ovulation and treat her problem that's infertility. So if the intention is correct any other argument may not stand valid in the court as OHSS is a known complication of these injections in few women.
Its good to know you are also in XXXXXXX If you wish, you can meet me at the following address with prior appointment:
Dr.Mahesh Koregol.
XXXXXXX XXXX
XXXXXXX
Let me know if I can be of more help.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I will definitely go to court as i have a llb degree myself. I went to Infertility treatment of my wife who was healthy fit active and energetic woman. There are documented literature available in the medical field how pcos woman with young age are at high risk and anything like this cant be done without consent of us. Life is a great leveller. No, u cannot say there is no liability of doctor. I have many decided cases from all over the world on similar context of OHSS that have held the judgement towards the patient side. If there is no law till now, I will certainly make sure there should be a law as i am going to write letters to media and all authorities whoever are required. And change will happen because a person's life is sacred and not to be played around with. Dr XXXXXXX is also tied up with XXXXXXX fertility center so there is no use in going there to follow up. But fortunately, I have taken the opinion of some expert doctors in the field who have told me it could have been prevented and close monitoring is required which was not done. Also when the risk is high consent is mandatory, if it didn't have any legal sanction then there wouldn't have been ritual of taking consent in medicinal field. My wife will recover hopefully but the trauma, pain in those 18 days i faced cant be measured and explained.
Thank u doctor.
At the moment my aim is to get my wife out of this . And I will provide u with a judgement contrary to what u have opined in the times to come.
And yes . OHSS is a known complication. Infact it is everywhere stated as OHSS is a well known iatrogenic complication. So doctors should have known about it and informed us about the risks involved before starting the treatment as it is a well known complication.
Thank u doctor.
At the moment my aim is to get my wife out of this . And I will provide u with a judgement contrary to what u have opined in the times to come.
And yes . OHSS is a known complication. Infact it is everywhere stated as OHSS is a well known iatrogenic complication. So doctors should have known about it and informed us about the risks involved before starting the treatment as it is a well known complication.
Brief Answer:
Wish your wife early recovery and good health
Detailed Answer:
Hi,
I understand the pain you and your wife are going through. It is difficult times for you both. I am ready to help her in anyway you wish to recover completely as it is first priority.
You know the legal aspects better as you are lawyer yourself and have good knowledge. You can pursue what you think is the best way.
Since your wife has got her periods she is likely to recover well and soon. I pray for her early recovery and good health.
I will be available for any follow up questions which will help you both to come out of this situation and lead a normal life soon.
Feel free to contact me anytime for any help that you may require.
Regards,
Dr. Mahesh Koregol.
Wish your wife early recovery and good health
Detailed Answer:
Hi,
I understand the pain you and your wife are going through. It is difficult times for you both. I am ready to help her in anyway you wish to recover completely as it is first priority.
You know the legal aspects better as you are lawyer yourself and have good knowledge. You can pursue what you think is the best way.
Since your wife has got her periods she is likely to recover well and soon. I pray for her early recovery and good health.
I will be available for any follow up questions which will help you both to come out of this situation and lead a normal life soon.
Feel free to contact me anytime for any help that you may require.
Regards,
Dr. Mahesh Koregol.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor. My wife was discharged on 31/10/2015 after 18 days in hospital . Since then there was no tummy bloating and her abdominal girth was 86 cm. Her menses were only for 2 days. Today her abdominal girth has increased to 92cm and she has severe breathing problem again. I am worried again if the fluid has started accumulating again.. OHSS was resolved but i dont understand why these complications again.. Our next appointment in hospital is on saturday but my wife is finding it very difficult to manage. Kindly explain me why this is happening again as OHSS looked like it has gone for around a week. Also kindly advise so as to what we must do to control her breathlessness and tummy bloating. Note that she is able to pass motions and urine normally.
Brief Answer:
Ultrasound scan is required today
Detailed Answer:
Hi,
I understand your worries after discharge from hospital. There are some important points I am going to mention. Please follow them:
1) Please do take your wife to the doctor again for a check up. If there's severe breathlessness she needs to be checked to figure out the status of the pleural effusion and ascitis. Your doctor will do an ultrasound and let you know if there is fluid accumulation leading to increased abdominal girth.
2) Once resolved usually OHSS does not recur. What was the pregnancy hormone level at the time of discharge? If I may ask. If it was less than 50 unlikely its continuing pregnancy... Having said that it is not wise to speculate things and it would be better to get an ultrasound abdomen and pelvis and a chest scan/X-ray .
3)Did she have any comorbid conditions like bronchial asthma or any lung problems before? because such preexisting lung conditions worsen the situation.
4) Please do not ignore symptoms and get her checked .
Let me know if you need any assistance.
Regards
Ultrasound scan is required today
Detailed Answer:
Hi,
I understand your worries after discharge from hospital. There are some important points I am going to mention. Please follow them:
1) Please do take your wife to the doctor again for a check up. If there's severe breathlessness she needs to be checked to figure out the status of the pleural effusion and ascitis. Your doctor will do an ultrasound and let you know if there is fluid accumulation leading to increased abdominal girth.
2) Once resolved usually OHSS does not recur. What was the pregnancy hormone level at the time of discharge? If I may ask. If it was less than 50 unlikely its continuing pregnancy... Having said that it is not wise to speculate things and it would be better to get an ultrasound abdomen and pelvis and a chest scan/X-ray .
3)Did she have any comorbid conditions like bronchial asthma or any lung problems before? because such preexisting lung conditions worsen the situation.
4) Please do not ignore symptoms and get her checked .
Let me know if you need any assistance.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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