Treatment of severe ovarian hyperstimulation syndrome by a conservative medical approach

Objective. To assess the value of a conservative medical therapeutic approach in the management of severe ovarian hyperstimulation syndrome (OHSS). Design. Prospective longitudinal study. Setting. Assisted Reproduction Unit of the Hospital Clinic i Provincial de Barcelona, a tertiary care setting. Patients. Twenty-five women with ascites because of OHSS. Interventions. Patients were treated by strict bed rest, low-sodium diet (60 mEq/day), plasma volume expansion with albumin (50 g/day of salt-poor albumin) and diuretics (20 mg of furosemide given intravenously every 8-12 hours). Main outcome measures. Measurement al admission and 48 hours after commencement of treatment of the following: body weight, mean arterial pressure, heart rate, hematocrit, hemoglobin concentration, leukocyte and platelet counts, urine volume, sodium excretion, serum sodium, serum creatinine, plasma renin activity, and plasma aldosterone, norepinephrine, antidiuretic hormone, and atrial natriuretic peptide concentrations. Results. After 2 days of therapy there was married improvement in clinical symptoms, standard laboratory parameters, diuresis and urinary sodium excretion in all patients. There was also a significant decrease in the plasma levels of volume-dependent endogenous vasoactive substances in the five patients in whom these measurements were repeated during treatment. The length of treatment with albumin plus furosemide ranged between 2 and 6 days with an average of 3.3 and it correlated directly with the severity of the syndrome. The hospital stay ranged from 4 to 10 days (mean 6.5 days). All patients recovered without any complication. Conclusions. Severe ovarian hyperstimulation syndrome can be managed using the proposed conservative medical approach.