Treatment of Mild Ovarian Hyperstimulation Syndrome (OHSS)
For mild OHSS, provide outpatient supportive care with oral hydration, NSAIDs for pain control, and close monitoring without routine thromboprophylaxis. 1, 2
Immediate Management Approach
Supportive Care
- Maintain adequate oral hydration to prevent hemoconcentration and support intravascular volume 2, 3
- Monitor fluid intake and output to ensure patients are maintaining appropriate hydration status 3
- Advise rest and activity modification while avoiding complete immobility, which increases thrombotic risk 4
Pain Management
- Use NSAIDs as first-line analgesics: naproxen 550 mg or ibuprofen 600-800 mg for mild-to-moderate pain 1
- Avoid aspirin before oocyte retrieval due to bleeding risk, though it may be considered post-retrieval 1
Thromboprophylaxis Decision
- Do NOT routinely initiate LMWH for mild OHSS - reserve thromboprophylaxis for moderate-to-severe cases 1, 4
- Exception: Start prophylactic LMWH (enoxaparin 40 mg subcutaneously daily) immediately if the patient has known thrombophilia or antiphospholipid syndrome, even with mild OHSS 5, 1
- The American College of Chest Physicians specifically recommends thromboprophylaxis only when OHSS becomes moderate-to-severe due to the hypercoagulable state from hemoconcentration and elevated estrogen 5, 1
Medications to Avoid
- Strongly avoid diuretics - they worsen hemoconcentration and intravascular volume depletion 2, 3
- Do not use routine anticoagulation unless specific risk factors are present 5
Monitoring Parameters
Clinical Assessment
- Monitor for progression to moderate/severe OHSS by assessing for increasing abdominal distension, significant weight gain (>2 kg), or worsening symptoms 3
- Watch for warning signs requiring escalation: severe abdominal pain, persistent nausea/vomiting, decreased urine output, or shortness of breath 6, 3
When to Escalate Care
- Transition to moderate/severe OHSS management if: clinically significant ascites develops, hemoconcentration occurs (hematocrit >41%), or oliguria develops 3
- At that point, initiate LMWH thromboprophylaxis and consider hospitalization for closer monitoring 1, 6
Outpatient Management Feasibility
- Mild OHSS can be safely managed as outpatient with appropriate protocols and patient education 6, 4
- Ensure patients understand warning signs and have clear instructions for when to seek urgent evaluation 6
- Schedule follow-up within 48-72 hours to reassess clinical status and ensure symptoms are not progressing 3
Special Considerations
High-Risk Patients
- Patients with polycystic ovary syndrome, high antral follicle counts, or elevated estradiol levels during stimulation require closer monitoring even with mild symptoms 1
- Those with underlying thrombophilia need prophylactic anticoagulation regardless of OHSS severity 5, 1