CLINICAL REPORT: The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome

Abstract

Previous experiences in subjects with other forms of third space fluid accumulation have shown that albumin is efficacious in preventing and correcting haemodynamic instability. Using a similar approach in an effort to increase the serum oncotic pressure and to reverse the leakage of fluids from the intravascular space, high risk subjects for severe ovarian hyperstimulation syndrome (SOHS) were treated with albumin. In a recent large study two high risk factors were identified, i.e. the number of oocytes and levels of serum oestradiol. Thirty-six women undergoing assisted reproductive techniques who presented both these factors, received intravenous albumin at a dose of 5% in Ringers lactate in doses of 500 ml during oocyte retrieval and 500 ml immediately thereafter in the recovery room. Daily measurements of urine output, serum and urine electrolytes, weight, abdominal girth, and haematocrit prior to and after oocyte retrieval revealed normal serum and urine electrolyte levels, and no signs of haemoconcentration. No patient in this study developed SOHS, and of course none had to be hospitalized. Vaginal ultrasound performed in the majority of the subjects revealed < or = 100 ml of peritoneal fluid 48-72 h after oocyte retrieval. The only complication from the use of intravenous albumin was the appearance of a 'flu-like condition' (low grade temperature, nausea and muscle pains) developed by 12 women between days 3 and 5 after oocyte collection. Intravenous albumin had thus prevented the development of severe ovarian hyperstimulation syndrome in an assisted reproduction programme.(ABSTRACT TRUNCATED AT 250 WORDS)

VEGF antagonist for the prevention of ovarian hyperstimulation syndrome: Current status

“…Nevertheless, a recent meta-analysis of five randomized controlled trials demonstrated that prophylactic albumin administration significantly reduced risk of developing OHSS. 43 Metformin an insulin sensitizer added to ovulation induction in women with PCOS undergoing IVF treatment with or without cabergoline has also been documented to reduce the risk of developing OHSS. Khattab et al in their work found a significant reduction in the incidence of this complication in the group taking metformin and concluded that Metformin is a safe, cheap drug that can help in prevention of OHSS.…”

A double-blind, randomized, placebo-controlled study to assess the efficacy of ketoconazole for reducing the risk of ovarian hyperstimulation syndrome

“…5,6,7 Early identification of the patients at risk and prevention of OHSS is clinically important. Several methods have been recommended for minimizing the probability of the syndrome in high risk pa tients including canceling the cycle before administration of hCG or reduction of the ovulatory hCG dose, 8 withhold ing luteal support with hCG, 9 cryopreservation of all em bryos for further use in a non-stimulated cycle, 10 repeated aspiration of ovarian follicles and early corpus luteum cysts, 11 administration of human albumin at the time of hCG injection, 12 use of GnRh analogue to trigger ovulation, 13 and vaginal aspiration of ascites. 14 Ketoconazole, a broad-spectrum imidazole antimycotic agent, was recently reported to reduce the incidence of OHSS in PCOS women undergoing superovulation program by gonadotropins.…”

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

“…Asch and colleagues first reported prophylactic administration of albumin prevented OHSS in 36 high risk patients (18). Shoham et al (10) described a similar benefit in a small random prospective study where 16 high risk OHSS patients received albumin and did not develop severe OHSS, whereas a control group (no albumin) had 4/15 develop severe OHSS.…”