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Received August 25, 2016; accepted August 25, 2016; published online September 24, 2016. Reprint requests: Practice Committee, American Society for Reproductive Medicine, 1209 Montgom-ery Hwy, Birmingham, Alabama 35216 (E-mail: ASRM@asrm.org). Fertility and Sterility® Vol. 106, No. 7, December 2016 0015-0282/$36.00
Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2016 Dec;106 (7):1634-1647. doi: 10.1016/j.fertnstert.2016.08.048. Epub 2016 Sep 24.
This systematic review aims to identify who is at high risk for developing ovarian hyperstimulation syndrome, along with evidence-based strategies to prevent it and replaces the document of the same name last published in 2016.
Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Practice Committee of the American Society for Reproductive Medicine. Published: September 24, 2016 DOI: https://doi.org/10.1016/j.fertnstert.2016.08.048.
- Samantha Pfeifer, Samantha Butts, Daniel Dumesic, Gregory Fossum, Clarisa Gracia, Andrew La Barbera,...
- 2016
- WHO IS AT HIGH RISK FOR MODERATE AND SEVERE OHSS?
- Summary Statements
- Summary Statement
- Summary Statement
- R Summary Statement
- Summary Statements
- Summary Statement
- Summary Statement
- Summary Statement
- Summary Statement
- Can Miscellaneous Treatments Prevent OHSS Risk?
- TREATMENT OF OHSS
- Summary Statement
- Summary Statement
- CONCLUSIONS
- RECOMMENDATIONS
- Acknowledgments:
OHSS could theoretically occur in any woman undergoing controlled ovarian stimulation with gonadotropins. However, evidence indicates that there are some women who are at a much higher risk. Identifying these women is essential to lowering, and potentially eliminating, the incidence of OHSS. After a systematic search of the literature was per-forme...
There is good evidence to support the use of ovarian stim-ulation protocols using GnRH antagonists in order to reduce the risk of OHSS. (Grade A) There is insuf cient evidence that clomiphene indepen- fi dently reduces OHSS risk. (Grade C)
There is fair evidence that aspirin reduces the incidence of OHSS based on a single randomized trial comparing aspirin alone with no treatment and another study comparing combined acetylsalicylic acid and steroid treatment with no treatment. (Grade B)
There is good evidence that metformin decreases the risk of OHSS risk in PCOS patients. (Grade A)
There is insuf cient evidence to recommend coasting for fi the prevention of OHSS. (Grade C)
There is insuf cient evidence to recommend a lower dose fi of hCG to trigger oocyte maturation for reduction in OHSS risk based on one underpowered randomized trial. (Grade C) There is good evidence to recommend the use of a GnRH agonist to trigger oocyte maturation prior to oocyte retrieval in order to reduce the risk of OHSS. (Grade A) There is g...
There is good evidence that dopamine agonist administra-tion starting at the time of hCG trigger for several days re-duces the incidence of OHSS. (Grade A)
Given mixed results in the literature, there is insuf cient fi evidence to conclusively state that albumin lowers the risk of OHSS. (Grade C)
There is fair evidence that calcium lowers OHSS risk. (Grade B)
Based on the results of two small RCTs, there is fair evi-dence that cryopreservation prevents OHSS. (Grade B)
There are insuf cient data to make recommendations fi regarding the use of luteal antagonist administration, letro-zole, methylprednisolone, intramuscular progesterone, or ketoconazole to mitigate OHSS risk.
Symptomatic moderate or severe OHSS is a hypovolemic-hyponatremic state. Treatment usually involves uid replace-fl ment to maintain intravascular perfusion and supportive care. A rare but life-threatening risk for patients with severe hypo-volemia involves arterial or venous thromboembolism; there-fore, prophylactic anticoagulation is warranted in ...
There is fair evidence to recommend paracenteses or culdo-centeses for the management of OHSS in an outpatient setting. (Grade B)
There is insuf cient evidence to support the use of volume fi expanders alone for the treatment of OHSS (Grade C). The studies reporting use of volume expanders in OHSS treat-ment have not been uniform in treatment protocols. Some use diuretics and others include dopamine.
OHSS is a known complication of controlled ovarian stimula-tion. Ideally, women at risk for this disorder should be identi-ed prior to stimulation, and stimulation protocols should be fi selected that minimize the risk of OHSS. The use of GnRH antagonist protocols with a GnRH agonist (with or without low-dose hCG) to trigger nal oocyte maturation o...
Women with PCOS, elevated AMH values, and elevated AFC may bene t from ovarian stimulation protocols that fi reduce the risk of OHSS. (Grade B) Ovarian stimulation protocols using GnRH antagonists are preferable in women at high risk of OHSS. (Grade A) The use of a GnRH agonist to trigger oocyte maturation prior to oocyte retrieval is recommended t...
This report was developed under the direction of the Practice Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. Although this document re ects fl appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved ...
Reanalysis of the datasets was performed according to three different means of defining septate uterus: following the recommendations of the American Society for Reproductive Medicine (ASRM), a 2016 update of those of the American Fertility Society from 1988 (ASRM-2016: internal fundal indentation depth ≥ 1.5 cm, angle of internal indentation < ...
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