An ounce of prevention: outpatient management of the ovarian hyperstimulation syndrome.
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.
Fluker
M R
MR
Genesis Fertility Centre, Vancouver, British Columbia, Canada. fluker@genesis_fertility.com
Copeland
J E
JE
Yuzpe
A A
AA
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
D006063:Chorionic Gonadotropin; D012709:Serum Albumin; D004958:Estradiol