title: Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study.
abstract: BACKGROUND
  Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase.
  
  
  METHODS
  This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible.
  
  
  RESULTS
  11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P < 0.001) by the end of the monitoring period, indicating rapid resolution of severe OHSS.
  
  
  CONCLUSIONS
  The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.
authors.affiliation: Eugonia Assisted Reproduction Unit, 11528, Athens, Greece.
authors.forename: George T
authors.initials: GT
authors.lastname: Lainas
authors.forename: Efstratios M
authors.initials: EM
authors.lastname: Kolibianakis
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Sfontouris
authors.forename: Ioannis Z
authors.initials: IZ
authors.lastname: Zorzovilis
authors.forename: George K
authors.initials: GK
authors.lastname: Petsas
authors.forename: Theoni B
authors.initials: TB
authors.lastname: Tarlatzi
authors.forename: Basil C
authors.initials: BC
authors.lastname: Tarlatzis
authors.forename: Trifon G
authors.initials: TG
authors.lastname: Lainas
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015925:Cryopreservation; D004624:Embryo Transfer; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D054315:Oocyte Retrieval / Q000009:adverse effects; D010045:Outpatients; D016471:Ovarian Hyperstimulation Syndrome / Q000188:drug therapy*; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix