Download PDF
Semin Reprod Med 2010; 28(6): 532-539
DOI: 10.1055/s-0030-1265681
© Thieme Medical Publishers

Treatment of Ovarian Hyperstimulation Syndrome

Mohamed Aboulghar1
  • 1Professor of Obstetrics and Gynecology, Cairo University, Egypt; Clinical Director, The Egyptian IVF Center, Maadi, Cairo, Egypt
Further Information

Publication History

Publication Date:
16 November 2010 (online)

    Permissions and Reprints

ABSTRACT

Mild forms of ovarian hyperstimulation syndrome (OHSS) do not require treatment. Moderate OHSS should be followed up on an outpatient basis with no specific treatment. Severe OHSS requires proper evaluation. Investigations are done to evaluate hematocrit, electrolytes, and kidney and liver function. Conservative treatment with intravenous (IV) fluids and close monitoring is usually done. Intensive care admission is indicated in cases with severe respiratory distress or major electrolyte imbalance with elevated serum creatinine. Crystalloids in the form of IV saline and colloids as albumin or hydroxyethyl starch are commonly used to expand intravascular volume. Dopamine can be used to improve diuresis, and prophylactic heparin is administered to prevent venous thrombosis. Diuretics are generally contraindicated because they may further contract intravascular volume. Abdominal or vaginal aspiration of ascitic fluid results in marked improvement of symptoms, improved diuresis, and shortened hospital stay. The current trend to treat patients with IV fluids, albumin, and to perform aspiration of ascitic fluid on an outpatient basis has been found to be a more cost-effective protocol of treatment.

KEYWORDS

OHSS treatment - aspiration of ascitic fluid - IV albumin - hydroxyethyl starch

REFERENCES

  • 1 Rizk B, Aboulghar M. Modern management of ovarian hyperstimulation syndrome.  Hum Reprod. 1991;  6(8) 1082-1087
    PubMedGoogle Scholar
  • 2 Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS).  Hum Reprod Update. 2003;  9(1) 77-96
    CrossrefPubMedGoogle Scholar
  • 3 Borenstein R, Elhalah U, Lunenfeld B, Schwartz Z S. Severe ovarian hyperstimulation syndrome: a reevaluated therapeutic approach.  Fertil Steril. 1989;  51(5) 791-795
    PubMedGoogle Scholar
  • 4 Aboulghar M A, Mansour R T, Serour G I, Sattar M A, Amin Y M, Elattar I. Management of severe ovarian hyperstimulation syndrome by ascitic fluid aspiration and intensive intravenous fluid therapy.  Obstet Gynecol. 1993;  81(1) 108-111
    PubMedGoogle Scholar
  • 5 Aboulghar M A, Mansour R T. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures.  Hum Reprod Update. 2003;  9(3) 275-289
    CrossrefPubMedGoogle Scholar
  • 6 Rizk B, Aboulghar M. Classification, pathophysiology and management of ovarian hyperstimulation syndrome. In: Brinsden P In Vitro Fertilization and Assisted Reproduction. London, United Kingdom; Taylor and Francis 1995: 217-258
    Google Scholar
  • 7 Navot D, Bergh P A, Laufer N et al. The ovarian hyperstimulation syndrome. In: Adashe EY, Rock JA, Rosenwaks Z Reproductive Endocrinology, Surgery, and Technology. Philadelphia, PA; Lippincott-Raven 1996: 2225-2232
    Google Scholar
  • 8 Balasch J, Fábregues F, Arroyo V, Jiménez W, Creus M, Vanrell J A. Treatment of severe ovarian hyperstimulation syndrome by a conservative medical approach.  Acta Obstet Gynecol Scand. 1996;  75(7) 662-667
    CrossrefPubMedGoogle Scholar
  • 9 Abdalla HI, Rizk B Assisted Reproductive Technology. Abingdon, Oxford, United Kingdom; Health Press 2004: 37-39
    Google Scholar
  • 10 Schenker J G. Prevention and treatment of ovarian hyperstimulation.  Hum Reprod. 1993;  8(5) 653-659
    PubMedGoogle Scholar
  • 11 Fábregues F, Balasch J, Manau D et al. Haematocrit, leukocyte and platelet counts and the severity of the ovarian hyperstimulation syndrome.  Hum Reprod. 1998;  13(9) 2406-2410
    CrossrefPubMedGoogle Scholar
  • 12 Kodama H, Fukuda J, Karube H, Matsui T, Shimizu Y, Tanaka T. Characteristics of blood hemostatic markers in a patient with ovarian hyperstimulation syndrome who actually developed thromboembolism.  Fertil Steril. 1995;  64(6) 1207-1209
    PubMedGoogle Scholar
  • 13 Shapiro A G, Thomas T, Epstein M. Management of hyperstimulation syndrome.  Fertil Steril. 1977;  28(3) 237-239
    PubMedGoogle Scholar
  • 14 Kissler S, Neidhardt B, Siebzehnrübl E, Schmitt H, Tschaikowsky K, Wildt L. The detrimental role of colloidal volume substitutes in severe ovarian hyperstimulation syndrome: a case report.  Eur J Obstet Gynecol Reprod Biol. 2001;  99(1) 131-134
    CrossrefPubMedGoogle Scholar
  • 15 Abramov Y, Fatum M, Abrahamov D, Schenker J G. Hydroxyethyl starch versus human albumin for the treatment of severe ovarian hyperstimulation syndrome: a preliminary report.  Fertil Steril. 2001;  75(6) 1228-1230
    CrossrefPubMedGoogle Scholar
  • 16 Rabinerson D, Ben Rafael Z, Keslin J, Zolotarsky V, Dekel A. 10% hydroxyethyl starch for plasma expansion in the treatment of severe ovarian hyperstimulation syndrome. A case report.  J Reprod Med. 2001;  46(1) 68-70
    PubMedGoogle Scholar
  • 17 Gamzu R, Almog B, Levin Y, Avni A, Lessing J B, Baram A. Efficacy of hydroxyethyl starch and Haemaccel for the treatment of severe ovarian hyperstimulation syndrome.  Fertil Steril. 2002;  77(6) 1302-1303
    CrossrefPubMedGoogle Scholar
  • 18 Aboulghar M A, Mansour R T, Serour G I, Amin Y. Ultrasonically guided vaginal aspiration of ascites in the treatment of severe ovarian hyperstimulation syndrome.  Fertil Steril. 1990;  53(5) 933-935
    PubMedGoogle Scholar
  • 19 Ferraretti A P, Gianaroli L, Diotallevi L, Festi C, Trounson A. Dopamine treatment for severe ovarian hyperstimulation syndrome.  Hum Reprod. 1992;  7(2) 180-183
    PubMedGoogle Scholar
  • 20 Tsunoda T, Shibahara H, Hirano Y et al. Treatment for ovarian hyperstimulation syndrome using an oral dopamine prodrug, docarpamine.  Gynecol Endocrinol. 2003;  17(4) 281-286
    PubMedGoogle Scholar
  • 21 Rollene N L, Amols M H, Hudson S BA, Coddington C C. Treatment of ovarian hyperstimulation syndrome using a dopamine agonist and gonadotropin releasing hormone antagonist: a case series.  Fertil Steril. 2009;  92(3) 1169, e15-e17
    PubMedGoogle Scholar
  • 22 Lainas T G, Sfontouris I A, Zorzovilis I Z, Petsas G K, Lainas G T, Kolibianakis E M. Management of severe early ovarian hyperstimulation syndrome by re-initiation of GnRH antagonist.  Reprod Biomed Online. 2007;  15(4) 408-412
    CrossrefPubMedGoogle Scholar
  • 23 Lainas T G, Sfontouris I A, Zorzovilis I Z et al. Management of severe OHSS using GnRH antagonist and blastocyst cryopreservation in PCOS patients treated with long protocol.  Reprod Biomed Online. 2009;  18(1) 15-20
    CrossrefPubMedGoogle Scholar
  • 24 Mills M S, Eddowes H A, Fox R, Wardle P G. Subclavian vein thrombosis: a late complication of ovarian hyperstimulation syndrome.  Hum Reprod. 1992;  7(3) 370-371
    PubMedGoogle Scholar
  • 25 Hignett M, Spence J E, Claman P. Internal jugular vein thrombosis: a late complication of ovarian hyperstimulation syndrome despite mini-dose heparin prophylaxis.  Hum Reprod. 1995;  10(12) 3121-3123
    PubMedGoogle Scholar
  • 26 Kodama H, Fukuda J, Karube H, Matsui T, Shimizu Y, Tanaka T. Status of the coagulation and fibrinolytic systems in ovarian hyperstimulation syndrome.  Fertil Steril. 1996;  66(3) 417-424
    PubMedGoogle Scholar
  • 27 Katz Z, Lancet M, Borenstein R, Chemke J. Absence of teratogenicity of indomethacin in ovarian hyperstimulation syndrome.  Int J Fertil. 1984;  29(3) 186-188
    PubMedGoogle Scholar
  • 28 Bar-Hava I, Orvieto R, Dicker D, Dekel A, Peley D, Ben-Rafael Z. A severe case of ovarian hyperstimulation syndrome: 65 liters of ascites aspirated in an on-going IVF-ET twin pregnancy.  Gynecol Endocrinol. 1995;  9(4) 295-298
    CrossrefPubMedGoogle Scholar
  • 29 Rabau E, David A, Serr D M, Mashiach S, Lunenfeld B. Human menopausal gonadotropins for anovulation and sterility. Results of 7 years of treatment.  Am J Obstet Gynecol. 1967;  98(1) 92-98
    PubMedGoogle Scholar
  • 30 Thaler I, Yoffe N, Kaftory J K, Brandes J M. Treatment of ovarian hyperstimulation syndrome: the physiologic basis for a modified approach.  Fertil Steril. 1981;  36(1) 110-113
    PubMedGoogle Scholar
  • 31 Padilla S L, Zamaria S, Baramki T A, Garcia J E. Abdominal paracentesis for the ovarian hyperstimulation syndrome with severe pulmonary compromise.  Fertil Steril. 1990;  53(2) 365-367
    PubMedGoogle Scholar
  • 32 Al-Ramahi M, Leader A, Claman P, Spence J. A novel approach to the treatment of ascites associated with ovarian hyperstimulation syndrome.  Hum Reprod. 1997;  12(12) 2614-2616
    CrossrefPubMedGoogle Scholar
  • 33 Abuzeid M I, Nassar Z, Massaad Z, Weiss M, Ashraf M, Fakih M. Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome.  Hum Reprod. 2003;  18(2) 370-373
    CrossrefPubMedGoogle Scholar
  • 34 Grochowski D, Sola E, Kulikowski M, Kuczyński W, Wołczyński S, Szamatowicz M. Successful outcome of severe ovarian hyperstimulation syndrome (OHSS) with 27 liters of ascitic fluid removed by paracentesis.  J Assist Reprod Genet. 1995;  12(6) 394-396
    CrossrefPubMedGoogle Scholar
  • 35 Raziel A, Friedler S, Schachter M, Strassburger D, Bukovsky I, Ron-El R. Transvaginal drainage of ascites as an alternative to abdominal paracentesis in patients with severe ovarian hyperstimulation syndrome, obesity, and generalized edema.  Fertil Steril. 1998;  69(4) 780-783
    CrossrefPubMedGoogle Scholar
  • 36 Ozgun M T, Batukan C, Oner G, Uludag S, Aygen E M, Sahin Y. Removal of ascites up to 7.5 liters on one occasion and 45 liters in total may be safe in patients with severe ovarian hyperstimulation syndrome.  Gynecol Endocrinol. 2008;  24(11) 656-658
    CrossrefPubMedGoogle Scholar
  • 37 Ceyhan S T, Goktolga U, Karasahin E, Alanbay I, Duru N K. Continuous vaginal and bilateral thoracic fluid drainage for management of severe ovarian hyperstimulation syndrome.  Gynecol Endocrinol. 2008;  24(9) 505-507
    CrossrefPubMedGoogle Scholar
  • 38 Friedler S, Rachstein A, Bukovsky I, Ron-El R, Raziel A. Unilateral hydrothorax as a sole and recurrent manifestation of ovarian hyperstimulation syndrome following in-vitro fertilization.  Hum Reprod. 1998;  13(4) 859-861
    CrossrefPubMedGoogle Scholar
  • 39 Rinaldi M L, Spirtos N J. Chest tube drainage of pleural effusion correcting abdominal ascites in a patient with severe ovarian hyperstimulation syndrome: a case report.  Fertil Steril. 1995;  63(5) 1114-1117
    PubMedGoogle Scholar
  • 40 Shrivastav P, Nadkarni P, Craft I. Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity.  Hum Reprod. 1994;  9(5) 812-814
    PubMedGoogle Scholar
  • 41 Aboulghar M A, Mansour R T, Serour G I, Riad R, Ramzi A M. Autotransfusion of the ascitic fluid in the treatment of severe ovarian hyperstimulation syndrome.  Fertil Steril. 1992;  58(5) 1056-1059
    PubMedGoogle Scholar
  • 42 Stein S F, Fulenwider J T, Ansley J D et al. Accelerated fibrinogen and platelet destruction after peritoneovenous shunting.  Arch Intern Med. 1981;  141(9) 1149-1151
    CrossrefPubMedGoogle Scholar
  • 43 Splendiani G, Mazzarella V, Tozzo C, Elli M, Casciani C U. Autologous protein reinfusion in severe ovary hyperstimulation syndrome.  J Am Coll Surg. 1994;  179(1) 25-28
    PubMedGoogle Scholar
  • 44 Fukaya T, Chida S, Terada Y, Funayama Y, Yajima A. Treatment of severe ovarian hyperstimulation syndrome by ultrafiltration and reinfusion of ascitic fluid.  Fertil Steril. 1994;  61(3) 561-564
    PubMedGoogle Scholar
  • 45 Koike T, Araki S, Minakami H et al. Clinical efficacy of peritoneovenous shunting for the treatment of severe ovarian hyperstimulation syndrome.  Hum Reprod. 2000;  15(1) 113-117
    CrossrefPubMedGoogle Scholar
  • 46 Csokmay J M, Yauger B J, Henne M B, Armstrong A Y, Queenan J T, Segars J H. Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: “tap early and often” versus hospitalization.  Fertil Steril. 2010;  93(1) 167-173
    CrossrefPubMedGoogle Scholar

Mohamed AboulgharM.D. 

10 Geziret El Arab St.

Mohandessin 12411, Cairo, Egypt

Email: ghar@link.net

      >