Decreased incidence of severe ovarian hyperstimulation syndrome in high risk in-vitro fertilization patients receiving intravenous albumin: a prospective study

Abstract

The administration of human serum albumin has been reported to prevent severe ovarian hyperstimulation syndrome (OHSS) while undergoing ovarian stimulation protocols for in-vitro fertilization (IVF). This prospective, randomized study investigated the effectiveness of a single dose of human serum albumin (20 g) administered i.v. immediately after oocyte retrieval. Women enrolled in the IVF programme were treated with long gonadotrophin-releasing hormone agonist, triptorelin, and an individually-adjusted human menopausal gonadotrophin protocol. The criteria for inclusion in the study were young age, non-obesity, oestradiol concentration > 9200 pmol/l on the day of human chorionic gonadotrophin administration and > 20 follicles > 14 mm diameter as observed by transvaginal sonography. The treatment group (n = 22) received albumin while the control group (n = 18) did not. Patients were followed-up using ultrasound every 3 days. There was a significantly higher number of severe OHSS cases in the control group (n = 4) than in the treatment group (n = 0) (P = 0.035). Where the data base was restricted to patients with an oestradiol concentration > 15,000 pmol/l, the difference between control and treatment groups was highly significant (P = 0.008). These findings support the use of i.v. albumin in preventing severe OHSS during IVF treatment.

Administration of Intravenous Albumin around the Time of Oocyte Retrieval Reduces Pregnancy Rate without Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Meta-Analysis

“…The mechanisms for the putative effect of albumin in preventing OHSS have been proposed: albumin is thought to prevent the development of OHSS by increasing plasma oncotic pressure and binding of the vasoactive mediators of ovarian origin, such as VEGF [10,12,17] , but this has not been substantiated. Because capillary permeability is compromised in patients with OHSS, the duration of the oncotic effect would be insufficient to prevent OHSS [2] .…”

“…All studies used serum level of E 2 and/or number of follicles or oocytes as the basic risk factor of OHSS; however, their cutoff values varied across the 9 studies. Diagnosis of severe OHSS was done according to the criteria of Schenker (1978) in 4 of the 9 trials [9,12,15,16] , whereas others [10,18,19] used the criteria of Navot (1988) or Golan (1989).…”

“…The suggestion that IV albumin might prevent the development of severe OHSS was first introduced in 1993 [8] . Subsequently, 2 studies [9,10] also demonstrated that prophylactic IV administration of 25% albumin (20-50 g) at the time of oocyte retrieval significantly reduced the risk of OHSS when the E 2 levels are markedly elevated or there is a history of a previous episode of OHSS. However, a number of clinical trials showing the ineffectiveness of IV albumin have been conducted subsequently [11][12][13][14][15] ; in contrast, 1 study reported the beneficial effect of IV albumin for preventing OHSS [16] .…”

“…Although studies of its efficacy have had mixed results, a meta-analysis including 5 randomized controlled trials (RCTs) [9,10,12,15,16] denoted that prophylactic albumin administration significantly reduced the risk of developing OHSS [odds ratio (OR) = 0.28, 95% confidence interval (CI) = 0.11-0.73] [17] . Since then, further RCTs have evaluated the effectiveness of albumin infusion on the day of oocyte retrieval and consistently reported that this intervention is not a useful means of preventing the development of OHSS [18,19] .…”

Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis

“…Eight RCTs (n ¼ 1,199 patients) fulfilled the inclusion criteria and were included in the analysis, with no disagreement noted among the authors responsible for study selection (4)(5)(6)(17)(18)(19)(20)(21). Characteristics of the included studies are listed in Tables 1-3.…”