Aggressive Outpatient Management of Severe Ovarian Hyperstimulation Syndrome Avoids Complications and Prolonged Disease Course

Gustofson, R.L.; Browne, P.; Nest, Ronald L. Van; Richter, K.S.; Larsen, F.W.

doi:10.1016/j.fertnstert.2005.07.229

Cited by 4 publications

(1 citation statement)

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“…1 It is, therefore, important to look into novel approaches to improve outcomes and the management of complications associated with IVF. 8 Small retrospective studies 9 10 and a larger uncontrolled study 11 have suggested that transvaginal paracentesis can reduce the need for hospitalisation to between 2.9% and 14% of patients. Another small cohort study identified patients with moderate OHSS at risk of this progressing to severe OHSS and reduced this progression with only 1-3 paracentesis procedures.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial

White,

Pye,

Ridsdale

et al. 2024

BMJ Open

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IntroductionOvarian hyperstimulation syndrome (OHSS) is the most significant short-term complication of pharmacological ovarian stimulation. Symptoms range from mild abdominal discomfort to rare complications such as renal failure, thromboembolism and respiratory distress syndrome.Currently, clinical practice typically involves monitoring the patient until the condition becomes severe, at which point they are admitted to hospital, where drainage of ascitic fluid (paracentesis) may take place. Preliminary studies have indicated that earlier outpatient paracentesis may reduce the progression of OHSS and prevent hospitalisation in women.Methods and analysisThis UK, multicentre, pragmatic, two-arm, parallel-group, adaptive (group sequential with one interim analysis), open-label, superiority, confirmatory, group sequential, individually randomised controlled trial, with internal pilot will assess the clinical and cost-effectiveness and safety of outpatient paracentesis versus conservative management (usual care) for moderate or severe OHSS. 224 women from 20 National Health Service and private fertility units will be randomised (1:1) and followed up for up to 13.5 months. The primary outcome is the rate of OHSS related hospital admission of at least 24 hours within 28 days postrandomisation. The primary analysis will be an intention to treat with difference in hospitalisation rates as measure of treatment effect. Secondary outcomes include time to resolution of symptoms, patient satisfaction, adverse events and cost-effectiveness. A qualitative substudy will facilitate the feasibility of recruitment. Participant recruitment commenced in June 2022.Ethics and disseminationLondon—Southeast Research Ethics Committee approved the protocol (reference: 22/LO/0015). Findings will be submitted to peer-reviewed journals and abstracts to relevant national and international conferences, as well as being disseminated to trial participants and patient groups.Trial registration numberISRCTN71978064.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial

White,

Pye,

Ridsdale

et al. 2024

BMJ Open

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Treatment of Ovarian Hyperstimulation Syndrome

Rizk

2001

Ovarian Hyperstimulation Syndrome

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Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines

2017

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Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.

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Aggressive Outpatient Management of Severe Ovarian Hyperstimulation Syndrome Avoids Complications and Prolonged Disease Course

Cited by 4 publications

References 0 publications

Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial

Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial

Treatment of Ovarian Hyperstimulation Syndrome

Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines

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