- 1.Once the diagnosis of ovarian hyperstimulation syndrome is made, disease severity should be classified as mild, moderate, severe, or critical (III-B).
- 2.The physician prescribing gonadotropins should inform each woman of her personal risk for ovarian hyperstimulation syndrome (III-A).
- 3.In areas where patients do not have ready access to physicians familiar with the diagnosis and management of ovarian hyperstimulation syndrome, the physician prescribing gonadotropins should ensure that women are made aware that they should contact a physician or a member of the team within the hospital unit who has relevant experience, should the need arise (III-B).
- 4.Outpatient management is recommended for women with mild and moderate ovarian hyperstimulation syndrome. If outpatient management for more severe ovarian hyperstimulation syndrome is to be undertaken, the physician should ensure that the woman is capable of adhering to clinical instructions and that there is a system in place to assess her status every 1 to 2 days (III-A).
- 5.Paracentesis should be performed in admitted patients with tense ascites to alleviate their discomfort (II-2B).
- 6.Outpatient culdocentesis should be considered for the prevention of disease progression in moderate or severe ovarian hyperstimulation syndrome (II-2B).
- 7.Women with severe and critical ovarian hyperstimulation syndrome should be admitted to hospital for intravenous hydration and observation (III-A).
- 8.Intravenous hydration should be initiated with a crystalloid solution to prevent hemoconcentration and provide adequate end-organ perfusion. If end-organ perfusion is not maintained with a crystalloid solution, an alternate colloid solution should be administered (II-2B).
- 9.Pain relief in admitted patients should be managed with acetaminophen and/or opioid analgesics (III-B). Non-steroidal anti-inflammatory drugs with antiplatelet properties should not be used (III-B).
- 10.Women with severe ovarian hyperstimulation syndrome should be considered for treatment with prophylactic doses of anticoagulants (II-2B).
- 11.Critical ovarian hyperstimulation syndrome should be managed by a multidisciplinary team, according to the end organ affected (III-C).
Abbreviations:OHSS (Ovarian hyperstimulation syndrome), VEGF (vascular endothelial growth factor)
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This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Women have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice women should be provided with information and support that is evidence based, culturally appropriate and tailored to their needs. The values, beliefs and individual needs of each woman and her family should be sought and the final decision about the care and treatment options chosen by the woman should be respected.