Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review

Abstract

This Cochrane review shows a clear benefit from administration of i.v. albumin at the time of oocyte retrieval in prevention of severe OHSS in high-risk cases. Whether the number needed to treat would justify the routine use of albumin infusion in cases at risk of severe OHSS needs to be judged by clinical decision-makers.

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

“…This was followed by a number of RCTs of a small number of patients deemed to be at risk of OHSS on the basis of parameters of ovarian response, which appeared to show a reduction in the incidence of severe OHSS in the group receiving albumin. In 2002, a Cochrane meta-analysis [17] of 5 RCTs (n = 378) showed a significant reduction in the incidence of severe OHSS in women receiving IV albumin (OR = 0.28, 95% CI = 0.11-0.73). However, a systematic review by Delvigne and Rozenberg [2] , including several studies that had not been considered in the previous Cochrane review, found no significant difference in the incidence of OHSS between the patients receiving albumin (8.3%) and the controls (14.6%).…”

“…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] .…”

“…Because capillary permeability is compromised in patients with OHSS, the duration of the oncotic effect would be insufficient to prevent OHSS [2] . The osmotic function will be responsible for maintaining the intravascular volume in the event of capillary leakage, thus preventing the sequelae of hypovolemia, ascites and hemoconcentration [17] . However, it is unclear how this action would prevent the development of the clinical syndrome.…”

“…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] .…”

Ovarian hyperstimulation syndrome: pathophysiology and prevention

“…However, its efficacy is still a matter of debate. A review article published in 2002 [30] included five RCTs and evaluated the use of albumin in 193 women and 185 controls. The odds ratio for OHSS in the group treated with albumin was 0.28 (95%IC 0.11-0.73).…”