Ovarian Hyperstimulation Syndrome - eshre

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Combination of Ringer lactate + Dextrose 5% solution or NaCl 0.9%+ Dextrose 5% (standard) solutionPlasma expandersHEAS ( hydroxyethyl starch ) 6% solution in isotonic NaCl.Maximal daily dose: 33ml/kg in 250-500 ml per day, dropwise,utilising slow administration to avoid lung congestion.Albumin administrationIs only started if hypo-albuminemia (
4.5 Pregnancy after OHSS.The pregnancy rate in patients with OHSS is higher than average. This is becauseThe patients usually are young women, in their first ART cycles, with many oocytes and goodquality embryos. Several authors have reported an increase in early pregnancy loss in OHSSpatients (Raziel et al., 2002; Papanikolaou et al., 2004).4. CONCLUSIONS AND RECOMMENDATIONSAlthough theoretically known, OHSS remains underestimated because the perceivedincidence per gynaecologist is low. The affection is very traumatizing for the patient and herpartner. Subjective discomfort is very important and objective changes may be dramatic.Although long term sequelae are rare, they are serious (thrombo-embolism). Although fatalcases are rare, they go unreported and so may be underestimated and they are never inproportion to the indication for treatment (infertility in young healthy women).Essential recommendations therefore are:1. Gonadotropin treatment for ovulation induction only when all other options havefailed after a sufficiently long trying time.2. If gonadotropin stimulation for ovulation induction is unavoidable, one shoulduse “friendly” stimulation regimens aiming at “SOFT” ( single ovarian follicletreatment ): low dose step-up regimen, step-down regimen, or use antagonists,always utilising blood and sonographic control of ovarian response.3. HCG as an ovulation trigger should be replaced by safer methods (rLH,endogenous GnRH-surge by an agonist); they exist but are not commerciallyavailable.4. In IVF/ICSI the principle of obtaining “as many oocytes as possible” should bereplaced by softer stimulation regimens aiming at less oocytes of good quality.5. In risk situations the patient should be informed about possibilities such ascancelling, coasting or freezing for subsequent replacement.6. When signs of OHSS occur, the patient must be completely informed andhospitalization should be proposed at the slightest deterioration.7. These patients belong in a hospital ward where the clinical picture is known andthe personnel have expertise in its treatment and follow-up. Admission to anintensive care unit is necessary when critical OHSS develops.8. Registration of all cases of severe OHSS and their outcome should becomecompulsory in all ART programmes as well as after ovulation induction.5. REFERENCESAboulghar MA, Mansour RT, Serour GI en Amin T (1990) Ultrasonically guidedvaginal aspiration of ascites in the treatment of ovarian hyperstimulation syndrome. FertilSteril 53: 933-935.Aboulghar M, Evers JH en All-Inany H (2002) Intravenous albumin for preventing severe11
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Ovarian Hyperstimulation Syndrome - eshre

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