APPROACH TO THE TREATMENT OF ASCITES ASSOCIATED WITH OVARIAN HYPERSTIMULATION SYNDROME

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Ovarian hyperstimulation syndrome (OHSS) is almost cases an iatrogenic complication. Severe OHSS is characterised by ovarian enlargement, ascites, electrolyte imbalance, hypovolemia, and hemoconcentration. The pathophysiologic factors of this syndrome are not well known.
It has been observed that paracentesis is efficacious, provided that care is taken to reinfuse protein lost in the peritoneal exudate. For this reason, in two patients with severe OHSS, we used a dialytic technique of reinfusing concentrated ascitic fluid. Here, we report two cases of severe OHSS following IVF with massive ascites in which we reinfused concentrated ascites by ultrafiltration.
Through sonography-guided paracentesis, the ascitic fluid was concentrated by ultrafiltration and reinfused. The concentrated fluid was returned to the peripheral vein. In these patients, a progressive increase of diuresis was evident during treatment and subjective improvement was almost immediate. After treatment, hematologic and biochemical parameters had returned to normal limits. In treating severe OHSS, we have used the technique of reinfusing of concentrated ascitic fluid to avoid protein depletion induced by paracentesis. We were able to successfully restore to normal the hematological and biochemical imbalance with one treatment. Treatment of OHSS with this ultrafiltration and reinfusion method may help to resolve serious cases of OHSS and to treat severe OHSS.