AUTOLOGOUS PROTEIN REINFUSION IN SEVERE OVARY HYPERSTIMULATION SYNDROME

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is one of the mos t serious complications of ovulation induction by exogenous gonadotrop ins. The pathophysiologic factors of this syndrome are not well known. Increased capillary permeability causes third space fluid shift, whic h is responsible for ascites, pleural fluid, and edemas. Severe OHSS m ay result in renal failure, hypovolemic shock, thromboembolic disease, respiratory distress, and may cause death. It has been observed that paracentesis is efficacious, provided that care is taken to reinfuse p rotein lost in the peritoneal exudate. For this reason, in three patie nts with severe OHSS we have used a dialytic technique of reinfusion o f concentrated ascitic fluid. STUDY DESIGN: We treated three patients with severe OHSS (grade 6). Through sonography-guided paracentesis, th e ascitic fluid was concentrated by ultrafiltration and reinfused. Thi s treatment was instituted and performed once only. Ultrafiltration wa s obtained with a common high-flow dialyzer (polyacrylonitryle membran e). The concentrated fluid was returned to the patient in a peripheral vein. We have limited further treatment to restoration of fluid and e lectrolyte balance, avoiding in particular potentially teratogenic dru gs. RESULTS: In all three patients, a progressive increase of diuresis was evident during treatment and subjective improvement was almost im mediate. Fifteen days after treatment, hematologic and biochemical par ameters had returned within normal limits. CONCLUSIONS: In treating se vere OHSS, we have used the technique of reinfusion of concentrated as citic fluid to avoid protein depletion induced by paracentesis. We hav e been able to successfully restore to normal the hematologic and bioc hemical imbalance with one treatment. Use of the technique described h erein should be limited to carefully selected instances and treatment should be performed in an intensive care unit.