Outpatient management of severe early OHSS by administration of GnRH antagonist in the luteal phase: an observational cohort study

Reproductive Biology and Endocrinology

Trifon G Lainas²  Basil C Tarlatzis¹  Theoni B Tarlatzi¹  George K Petsas²  Ioannis Z Zorzovilis²  Ioannis A Sfontouris²  Efstratios M Kolibianakis¹  George T Lainas² 

[1] Unit for Human Reproduction, 1st Department of Obstetrics & Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Ring Road, Nea Efkarpia, 56429, Thessaloniki, Greece;Eugonia Assisted Reproduction Unit, 7 Ventiri Street, 11528, Athens, Greece

关键词: PCOS;    High risk for OHSS;    Luteolysis;    OHSS;    GnRH antagonist;   

Others  :  1150202
DOI  :  10.1186/1477-7827-10-69

 received in 2012-06-08, accepted in 2012-08-27,  发布年份 2012

【 摘 要 】

Background

Management of established severe OHSS requires prolonged hospitalization, occasionally in intensive care units, accompanied by multiple ascites punctures, correction of intravascular fluid volume and electrolyte imbalance. The aim of the present study was to evaluate whether it is feasible to manage women with severe OHSS as outpatients by treating them with GnRH antagonists in the luteal phase.

Methods

This is a single-centre, prospective, observational, cohort study. Forty patients diagnosed with severe OHSS, five days post oocyte retrieval, were managed as outpatients after administration of GnRH antagonist (0.25 mg) daily from days 5 to 8 post oocyte retrieval, combined with cryopreservation of all embryos. The primary outcome measure was the proportion of patients with severe OHSS, in whom outpatient management was not feasible.

Results

11.3% (95% CI 8.3%-15.0%) of patients (40/353) developed severe early OHSS. None of the 40 patients required hospitalization following luteal antagonist administration and embryo cryopreservation. Ovarian volume, ascites, hematocrit, WBC, serum oestradiol and progesterone decreased significantly (P < 0.001) by the end of the monitoring period, indicating rapid resolution of severe OHSS.

Conclusions

The current study suggests, for the first time, that successful outpatient management of severe OHSS with antagonist treatment in the luteal phase is feasible and is associated with rapid regression of the syndrome, challenging the dogma of inpatient management. The proposed management is a flexible approach that minimizes unnecessary embryo transfer cancellations in the majority (88.7%) of high risk for OHSS patients.

【 授权许可】

   
2012 Lainas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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