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VIII

TREATMENT OF OVARIAN
HYPERSTIMULATION SYNDROME


The clinical course of OHSS depends on its severity, whether complications
already occurred and the presence or absence of pregnancy (Rizk, 2002).
Clinical management involves dealing with electrolyte imbalance, neuro-
hormonal and haemodynamic changes, pulmonary manifestations, liver dys-
function, hypoglobulinaemia, febrile morbidity, thromboembolic phenomena
and neurological manifestations (Delvigne and Rozenberg, 2003). Despite
the increased prevalence of severe OHSS, the management of critical cases
presents a unique challenge to the reproductive endocrinologist and fertility
specialist (Rizk et al., 1991a). The general approach will be adapted to the
severity. Speci¬c approaches such as paracentesis and pleural puncture should
be carefully performed when necessary. Medical management requires familiar-
ity with the condition, and many of the problems that occur happen as a result
of lack of realization by intensivists and medical specialists that the syndrome is
different from similarly presenting medical syndromes. A better understanding
of the underlying pathophysiological mechanisms will help to re¬ne manage-
ment (Rizk, 1992; Rizk and Smitz, 1992). Novel treatment options for OHSS
are currently being investigated (Rizk and Nawar, 2004; Rizk and Aboulghar,
2005; Gomez-Gallego et al., 2005).


OUTPATIENT MANAGEMENT FOR MODERATE AND
SEVERE OHSS

Based on our classi¬cation, moderate OHSS will be followed up by regular
telephone calls at least daily, and by twice-weekly of¬ce visits (Rizk and
Aboulghar, 1999). Assessment at the of¬ce includes pelvic ultrasound, complete
blood count, liver function tests and coagulation pro¬le (Rizk and Nawar,
2004). Fluker et al. (2000) suggested that active outpatient intervention in the
early stages of OHSS, including paracentesis and albumin administration, can
avoid hospitalization while minimizing the progression and complications of
OHSS. Lincoln et al. (2002) assessed the effectiveness of outpatient treatment

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