From the Research
Management of Ovarian Hyperstimulation Syndrome (OHSS) should focus on supportive care and prevention of complications, with treatment varying based on severity, as outlined in the most recent guidelines 1.
Overview of OHSS Management
The management of OHSS involves a step-wise approach based on the severity of the syndrome. For mild cases, outpatient management is often sufficient, while more severe cases require hospitalization and more intensive interventions.
Treatment Based on Severity
- Mild OHSS: Outpatient management with oral hydration (2-3 liters daily), analgesics like acetaminophen for pain, and daily weight monitoring.
- Moderate OHSS: May require antiemetics such as ondansetron 4-8mg every 8 hours for nausea, and careful monitoring of fluid balance.
- Severe OHSS: Necessitates hospitalization for IV fluid administration (typically crystalloids), thromboprophylaxis with low molecular weight heparin (enoxaparin 40mg daily), and paracentesis for significant ascites causing respiratory distress or severe abdominal pain.
Key Considerations
- Intravascular Volume Expansion: Albumin infusion (25g IV) may be considered for intravascular volume expansion in cases with significant third-spacing of fluids.
- Monitoring: Regular monitoring of electrolytes, renal function, hematocrit, and coagulation parameters is essential, as OHSS can lead to hemoconcentration, electrolyte imbalances, and increased thrombotic risk.
- Prevention Strategies: Using GnRH antagonist protocols, coasting (withholding gonadotropins), and using GnRH agonist triggers instead of hCG in high-risk patients can help prevent OHSS during fertility treatments, as supported by recent studies 2, 3.
Recent Evidence and Recommendations
The most recent study 1 highlights the importance of early recognition and management of OHSS to prevent complications. It also underscores the role of supportive care and the potential for conservative management in selected cases. Guidelines from previous years 4, 5 provide a foundation for understanding the pathophysiology and management of OHSS, but the approach should always be tailored to the individual patient's risk factors and severity of symptoms.