An ounce of prevention: outpatient management of the ovarian hyperstimulation syndrome

Abstract

Objective: To evaluate a protocol of active outpatient management, including outpatient paracentesis and albumin administration, in women at risk for severe ovarian hyperstimulation syndrome (OHSS).

Design: Prospective cohort.

Setting: Freestanding IVF program.

Patient(s): Thirteen women progressing from moderate to severe OHSS.

Intervention(s): Bed rest and home monitoring with intermittent outpatient paracentesis and albumin administration.

Main outcome measure(s): Procedural outcomes and time to resolution of OHSS symptoms.

Result(s): The initial paracentesis occurred 14.1 +/- 3.3 days after oocyte retrieval, removing 1,735 +/- 506 mL of ascitic fluid. Eleven women required a second paracentesis and five women required a third paracentesis over the next 8 days. Six women received albumin on seven occasions because of hypoalbuminemia. The onset of diuresis occurred 2.8 +/- 1.9 days and recovery occurred 7. 4 +/- 3.0 days after the first paracentesis. There were no hospitalizations for OHSS symptoms and no complications. All 13 women had viable intrauterine pregnancies.

Conclusion: Active outpatient intervention in the early stages of OHSS, including paracentesis and albumin administration, can avoid hospitalization while minimizing the progression and complications of OHSS.