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). Design: Prospective cohort. Setting: Freestanding IVF program. Patient(s): Thirteen women progressing from moderate to severe OHSS. Intervention(s): Bed rest and home monitoring with intermittent outpatient paracentesis and albumin administration. Main Outcome Measure(s): Procedural outcomes and time to resolution of OHSS symptoms. Result(s): 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 a ver 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 7.1 +/- 3.0 days after the first paracentesis. There were no hospitalizations for OHSS symptoms and no complications. All 13 women had viable intrauterine pregnancies. Conclusion(s): 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. (C) 2000 by American Society for Reproductive Medicine.