Bloating can be a common (and uncomfortable) side effect of egg retrieval. In a traditional menstrual cycle, only one egg is ovulated per cycle. At the start of the cycle a cohort of follicles are recruited to grow, but typically only one dominant follicle will grow large enough to become that cycle’s ovulated egg. When you go through IVF, the goal is to produce multiple mature eggs in that cycle to be able to retrieve more. This improves the chances of producing one or more healthy embryos, in the hopes that at least one will successfully implant. But the actual bloating is something you'll likely want to decrease as soon as possible post-retrieval. Read on to discover five tips to help make post-egg-retrieval bloating subside quickly.
Why does bloating happen after egg retrieval?
Ovarian stimulation causes the ovaries to get big
While a normal ovary is almond- or grape-sized, in mild to moderate cases of Ovarian Hyperstimulation Syndrome (OHSS, more on that below) they can get up to 10 to 12 centimeters each—roughly the size of a peach or an orange. More stimulation may mean more eggs, but it also often means more side effects, including enlarged ovaries. Depending on your size, this drastic change in the ovaries can be felt and even seen with a distended abdomen.
Producing a greater number of eggs can cause physical effects like pelvic pressure, fullness and abdominal bloating. Your ovaries aren’t used to growing this many follicles in a single cycle, and those eggs can get big. That’s actually the point in IVF; eggs that can be retrieved and used for IVF need to reach maturity, growing to about five to 24 millimeters in diameter. That’s a significant size considering your ovaries are used to having only one mature egg per cycle (with the other premature follicles only reaching two to eight millimeters before disintegrating). Multiple large, mature eggs in the ovaries means the ovaries get larger.
Ovarian Hyperstimulation Syndrome
You can expect that stimulation of your ovaries will come with some symptoms though the severity of these is often dependent on the level of stimulation. Minimal stimulation will result in mild symptoms (bloating and breast tenderness) while extensive stimulation can result in side effects known as Ovarian Hyperstimulation Syndrome (OHSS). Mild cases of OHSS occur in 20 to 33 percent of IVF cycles and typically include feelings of bloating, discomfort, and nausea. Severe cases can be life-threatening, affecting blood pressure, and the function of key organ systems like the kidneys, liver and lungs, though this is rare and only happens in less than one to five percent of IVF cycles. Your doctor will modify your protocol if you are at high risk, including lowering medication doses and opting to freeze the embryos (instead of doing a fresh embryo transfer—a successful implantation will result in the release of B-hCG (beta-human chorionic gonadotropin) which makes OHSS even worse). Generally, OHSS symptoms worsen to a peak within a few days after retrieval and then subside over the course of a few days to two weeks.
The hormones at play during fertility treatments can lead to water retention and leaky blood vessels
Fluid in the pelvis, due to higher hormones can lead to leaky blood vessels and though the vessels return to normal as the ovarian stimulation hormones reside, while they are high the result can be bloating and water retention.
Almost all IVF cycles include a treatment called controlled ovarian stimulation (COS). This is when your doctor prescribes certain injectable medications to help make those follicles grow. These are the same types of hormones your body naturally makes, like follicle-stimulating hormone (FSH), to help follicles grow, but in higher levels than your ovaries typically see. In your IVF cycle, when more eggs are stimulated to grow, they all start producing estrogen. The high estrogen levels interact with the water balancing mechanism in the kidneys and stimulates water retention.
How long does bloating last post egg retrieval?
Not everyone experiences bloating, and it likely depends on the amount of stimulation and your body’s response to the medications, but bloating can last a few days and up to a week after your retrieval.
What makes bloating worse?
Dehydration. Not drinking enough water can cause many issues. First, lack of hydration makes your muscles stiff, crunchy and uncomfortable, and can make you feel crampy (don’t forget that your uterus is a muscle too). Secondly, without water to flush things out of your system, it’s going to take longer to get rid of the excess hormones, prolonging your discomfort.
- Constipation. You’re already filled up—you don’t need a backlog of fecal matter in there too. Constipation enhances the feeling of fullness and pressure. Ensure adequate water and fiber intake daily to help move things along and enjoy 20 to 30 minutes of gentle to moderate physical activity daily to help with those bowel movements. Need an extra push? Have some yogurt or try a little Magnesium citrate or Magnesium oxide which can act as a natural muscle relaxant and gentle laxative.
What can I do to help make post-retrieval bloating go away?
Drink plenty of fluids (water). The more water you drink, the better. Aim for two to three litres per day. This might be counter-intuitive since you’re already feeling full but drinking water will flush out the excess estrogen that is causing bloating. (For those experiencing OHSS: It’s important to follow you doctor’s instructions directly as they may include a limit of fluid intake per day.)
Get your electrolytes. Electrolytes help keep your body hydrated. This is the reason why some clinics will suggest eating salty foods after your retrieval. Some French fries might be your first thought for a salty snack, but there are much healthier and safer ways to get that salt. Ditch the fried foods which can increase cellular stress (and gas) in your body and add an electrolyte powder to your water instead. Alternatively, a cup or can of coconut water is rich in electrolytes, and delicious.
Consume lots of leafy greens and vegetables. The Brassica family of vegetables includes broccoli, Bok choy, cauliflower, collard greens and cabbage. Brassica vegetables contain a compound that helps the body process and break down estrogens. For more on diet, read more about what to eat before and after egg retrieval.
Increase fiber intake, aiming for 25 to 50 grams per day. We eliminate excess hormones through our urine and feces and dietary fiber helps ensure regular bowel movements which then helps eliminate hormone metabolites. For more, here's what to eat before and after egg retrieval.
- Take it easy but avoid complete bed rest. Some movement is good, like a 20-minute walk, especially if you’re constipated. Movement also supports your circulation to keep your system pumping fluids and eliminating excess hormones. You’ll want to avoid rigorous activities (like running, jump rope, martial arts) and anything that involves twisting or ab crunching (like twisting yoga poses, or kettlebell workouts). Since the ovaries are still big, there is a risk of them twisting, an emergency called ovarian torsion where the blood supply to the ovaries is stopped and a surgery to untwist is required.