What is the relationship between Ovarian Hyperstimulation Syndrome (OHSS) and aspirin (acetylsalicylic acid)?

From the Guidelines

Aspirin is not recommended for the prevention or treatment of Ovarian Hyperstimulation Syndrome (OHSS) in unselected patients undergoing assisted reproductive technologies, as the risk of venous thromboembolism (VTE) is low and the benefits of antithrombotic interventions do not outweigh the potential harms 1.

Key Considerations

• The American Society of Hematology 2018 guidelines suggest that antithrombotic interventions, including aspirin, are not warranted for the prevention of VTE in unselected women undergoing assisted reproduction, as the overall risk of VTE is low 1.
• However, for women with severe OHSS or those requiring hospitalization, the guidelines suggest that thrombosis prophylaxis with low-molecular-weight heparin (LMWH) may be considered, but the evidence for this is limited and the benefits and harms need to be carefully weighed 1.
• The use of aspirin or other antithrombotic agents for the prevention of OHSS or VTE in women undergoing assisted reproduction is not supported by strong evidence, and the potential risks and benefits need to be carefully considered on an individual basis 1.

Management of OHSS

• The standard treatment for OHSS includes rest, adequate hydration, pain management with acetaminophen, and close monitoring of symptoms.
• For mild OHSS, supportive care at home is usually sufficient, while moderate to severe cases may require hospitalization for intravenous fluids, pain management, and monitoring of electrolytes and kidney function.
• If symptoms of OHSS such as abdominal pain, bloating, nausea, or shortness of breath occur after fertility treatment, it is essential to contact a healthcare provider immediately rather than self-medicating with aspirin or other medications.

From the Research

OHSS and Aspirin

• Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment 2.
• The use of low-dose aspirin has been suggested as a potential preventative measure for OHSS, particularly in high-risk patients 3.
• A study found that low-dose aspirin therapy may be effective in preventing OHSS, with only two cases of severe OHSS occurring in patients who had received aspirin 3.
• The mechanism of thromboembolism in OHSS is complex and involves increased blood clotting, hemoconcentration, and hypovolemia, among other factors 4.
• Aspirin may help to prevent thromboembolic events in OHSS patients by inhibiting platelet aggregation and reducing inflammation 4.

Prevention and Management of OHSS

• Outpatient management of severe OHSS has been found to be safe and cost-effective compared to inpatient management, with paracentesis of ascitic fluid and supportive management being effective treatments 2.
• GnRH antagonist has been shown to be effective in treating early severe OHSS, although further research is needed to assess its role in this context 2.
• Low-dose gonadotrophin protocols and prophylactic albumin administration may also help to reduce the risk of OHSS 5.
• Cabergoline has been found to inhibit VEGF receptor 2 phosphorylation and associated vascular permeability, reducing the risk of OHSS 5.

Thromboembolism and OHSS

• Thromboembolic events are a serious complication of OHSS, with arterial events being more common than venous events 4.
• The use of anticoagulant therapy, such as low-dose heparin, may be effective in preventing thromboembolic events in OHSS patients 4.
• The combined administration of low-dose aspirin and low-dose heparin may be a useful preventative measure for thromboembolic events in OHSS patients 4.