Skip to main content
NCBI home page
Journal of Assisted Reproduction and Genetics logoLink to Journal of Assisted Reproduction and Genetics
. 2002 Apr;19(4):159–163. doi: 10.1023/A:1014828027282

Aggressive Outpatient Treatment of Ovarian Hyperstimulation Syndrome with Ascites Using Transvaginal Culdocentesis and Intravenous Albumin Minimizes Hospitalization

Stephen R Lincoln 1,✉, Michael S Opsahl 1, Keith L Blauer 1, Susan H Black 1, Joseph D Schulman 1
PMCID: PMC3455652  PMID: 12036082

Abstract

Purpose: To assess the effectiveness of outpatient treatment of Ovarian Hyperstimulation Syndrome associated with ascites. Methods: Forty-eight patients diagnosed with ovarian hyperstimulation and ascites from 2246 consecutive in vitro fertilization cycles were retrospectively studied. Patients were treated with outpatient transvaginal culdocentesis and rehydration with intravenous crystalloids and albumin every 1–3 days until resolution of symptoms or hospitalization was required. Outcomes measured included incidences of hospitalization, pregnancy outcomes, cycle characteristics, and oocyte donors versus nondonors comparisons. Results: No complications occurred from outpatient treatments, and 91.6% of patients avoided hospitalization. The pregnancy rate in patients undergoing transfer was 84.7%, and the spontaneous loss rate was 16%. Overall, the estradiol on day of hCG was 4331 pg/mL (range 2211–8167), ascites removed was 1910 cm3 (122–4000), and number of outpatient treatments was 3.4 (1–14). Nondonors averaged more outpatient treatments than donors (3.97 vs. 1.85), but similar rates of hospitalization (3/35 vs. 1/13). Conclusions: Outpatient treatment consisting of culdocentesis, intravenous rehydration, and albumin minimized the need for hospitalization in hyperstimulated patients.

Keywords: albumin, culdocentesis, ovarian hyperstimulation syndrome

Full Text

The Full Text of this article is available as a PDF (55.0 KB).

REFERENCES

  • 1.Medical Research International, Society for Assisted Reproductive Technology The American Fertility Society: In vitro fertilization-embryo transfer (IVF-ET) in the United States: 1990 results from the IVF-ET Registry. Fertil Steril. 1992;57:15–24. [PubMed] [Google Scholar]
  • 2.Schenker JG, Weinstin D. Ovarian hyperstimulation syndrome: A current survey. Fertil Steril. 1978;30:255. doi: 10.1016/s0015-0282(16)43508-9. [DOI] [PubMed] [Google Scholar]
  • 3.Sroitz J, Camus M, Devrorcy P, Beard P, Wisanto A, Van Steirteghem AC. Incidence of severe ovarian hyperstimulation syndrome after GnRH agonist/HMG superovulation for invitro fertilization. Hum Reprod. 1990;5:933–937. doi: 10.1093/oxfordjournals.humrep.a137223. [DOI] [PubMed] [Google Scholar]
  • 4.Tollan A, Holst N, Forsdahl F, Fadnes HO, Oian P, Maltau JM. Transcapillary fluid dynamics during ovarian stimulation for in vitro fertilization. Am J Obstet Gynecol. 1990;162:554–558. doi: 10.1016/0002-9378(90)90428-a. [DOI] [PubMed] [Google Scholar]
  • 5.Goldsman MP, Pedram A, Dominguez CE, Ciuffardi I, Levin E, Asch RH. Increased capillary permeability induced by human follicular fluid:Ahypothesis for an ovarian origin of the hyperstimulation syndrome [see comment] Fertil Steril. 1995;63:268–272. doi: 10.1016/s0015-0282(16)57353-1. [DOI] [PubMed] [Google Scholar]
  • 6.Borenstein R, Elhalah U, Lunenfeld B, Schwartz ZS. Severe ovarian hyperstimulation syndrome: A reevaluated therapeutic approach. Fertil Steril. 1989;51:791–795. doi: 10.1016/s0015-0282(16)60668-4. [DOI] [PubMed] [Google Scholar]
  • 7.Aboulghar MA, Mansour RT, Serour GI, Sattar MA, Amin YM, Elattar I. Management of severe ovarian hyperstimulation syndrome by ascitic fluid aspiration and intensive intravenous fluid therapy. Obstet Gynecol. 1993;81:108–111. [PubMed] [Google Scholar]
  • 8.Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: Prevention and treatment. Fertil Steril. 1992;58:249–261. doi: 10.1016/s0015-0282(16)55188-7. [DOI] [PubMed] [Google Scholar]
  • 9.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;69:780–783. doi: 10.1016/s0015-0282(98)00003-x. [DOI] [PubMed] [Google Scholar]
  • 10.Shoham Z, Weissman A, Barash A, Borenstein R, Schachter M, Insler V. Intravenous albumin for the prevention of severe ovarian hyperstimulation syndrome in an in vitro fertilization program: A prospective, randomized, placebo-controlled study. Fertil Steril. 1994;62:137–142. doi: 10.1016/s0015-0282(16)56829-0. [DOI] [PubMed] [Google Scholar]
  • 11.Golan A, Ron-El R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome:Anupdate review. Obstet Gynecol Surv. 1989;44:430–440. doi: 10.1097/00006254-198906000-00004. [DOI] [PubMed] [Google Scholar]
  • 12.Whelan JG, Vlahos NF. The ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:883–896. doi: 10.1016/s0015-0282(00)00491-x. [DOI] [PubMed] [Google Scholar]
  • 13.Navot D, Margalioth EJ, Laufer N, Birkenfeld A, Relou A, Rosler A, Schenker JG: Direct correlation between plasma renin activity and severity of the ovarian hyperstimulation syndrome. Fertil Steril 1987;48–57 [DOI] [PubMed]
  • 14.Delbaere A, Bergmann P, Gervy-Deroster C, Deschodt-Lanckman M, de Maertelaer V, Staroukine M, Camus M, Englert Y. Increased angiotensin II in ascites during severe ovarian hyperstimulation syndrome: Role of early pregnancy and ovarian gonadotropin stimulation. Fertil Steril. 1997;67:1038–1045. doi: 10.1016/s0015-0282(97)81436-7. [DOI] [PubMed] [Google Scholar]
  • 15.Levin ER, Rosen GF, Cassidente DL, Yee B, Meldrum D, Wisot A, Pedram A. Role of vascular endothelial cell growth factor in ovarian hyperstimulation syndrome. J Clin Invest. 1998;102:1978–1985. doi: 10.1172/JCI4814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Agrawal R, Tan SL, Wild S, Sladkevicius P, Engman L, Payne N, et al. Serum vascular endothelial growth factor concentrations in in vitro fertilization cycles predict the risk of ovarian hyperstimulation syndrome. Fertil Steril. 1999;71:287–293. doi: 10.1016/s0015-0282(98)00447-6. [DOI] [PubMed] [Google Scholar]
  • 17.Isik AZ, Gokmen O, Zeyneloglu HB, Kara S, Keles G, Gulekli B. Intravenous albumin prevents moderate-severe hyperstimulation in in-vitro fertilization patients:Aprospective, randomized and controlled study. Eur J Obstet Gynecol Reprod Biol. 1996;70:179–183. doi: 10.1016/s0301-2115(95)02603-7. [DOI] [PubMed] [Google Scholar]
  • 18.Asch RH, Ivery G, Goldsman M, Fredrick JL, Stone SC, Balmaceda JP. The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum Reprod. 1993;8:1015–1020. doi: 10.1093/oxfordjournals.humrep.a138185. [DOI] [PubMed] [Google Scholar]
  • 19.Chen CD, Wu MY, Yang JH, Chen SU, Ho HN, Yang YS. Intravenous albumin does not prevent the development of severe ovarian hyperstimulation syndrome. Fertil Steril. 1997;68:287–291. doi: 10.1016/s0015-0282(97)81517-8. [DOI] [PubMed] [Google Scholar]
  • 20.Isik AZ, Vicdan K, Alaybeyouglu L. Does IV Albumin prevent severe ovarian hyperstimulation? Fertil Steril. 1998;69:356–357. doi: 10.1016/s0015-0282(98)90060-7. [DOI] [PubMed] [Google Scholar]
  • 21.Aboulghar MA, Mansour RT, Serour GI, Amin Y. Ultrasonically guided vaginal aspiration of ascites in the treatment of severe ovarian hyperstimulation syndrome. Fertil Steril. 1990;53:933–935. doi: 10.1016/s0015-0282(16)53535-3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Assisted Reproduction and Genetics are provided here courtesy of Springer Science+Business Media, LLC

RESOURCES