title: 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).
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Freestanding IVF program.
  
  
  METHODS
  Thirteen women progressing from moderate to severe OHSS.
  
  
  METHODS
  Bed rest and home monitoring with intermittent outpatient paracentesis and albumin administration.
  
  
  METHODS
  Procedural outcomes and time to resolution of OHSS symptoms.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Genesis Fertility Centre, Vancouver, British Columbia, Canada. fluker@genesis_fertility.com
authors.forename: M R
authors.initials: MR
authors.lastname: Fluker
authors.forename: J E
authors.initials: JE
authors.lastname: Copeland
authors.forename: A A
authors.initials: AA
authors.lastname: Yuzpe
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D002985:Clinical Protocols; D004231:Diuresis; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D018670:Monitoring, Ambulatory; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood / Q000517:prevention & control* / Q000628:therapy*; D019152:Paracentesis; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D006063:Chorionic Gonadotropin; D012709:Serum Albumin; D004958:Estradiol