THE USE OF INTRAVENOUS ALBUMIN IN PATIENTS AT HIGH-RISK FOR SEVERE OVARIAN HYPERSTIMULATION SYNDROME

Previous experiences in subjects with other forms of third space fluid accumulation have shown that albumin is efficacious in preventing and correcting haemodynamic instability. Using a similar approach in an e ffort to increase the serum oncotic pressure and to reverse the leakag e of fluids from the intravascular space, high risk subjects for sever e ovarian hyperstimulation syndrome (SOHS) were treated with albumin. In a recent large study two high risk factors were identified, i.e. th e number of oocytes and levels of serum oestradiol. Thirty-six women u ndergoing assisted reproductive techniques who presented both these fa ctors, received intravenous albumin at a dose of 5% in Ringers lactate in doses of 500 ml during oocyte retrieval and 500 ml immediately the reafter in the recovery room. Daily measurements of urine output, seru m and urine electrolytes, weight, abdominal girth, and haematocrit pri or to and after oocyte retrieval revealed normal serum and urine elect rolyte levels, and no signs of haemoconcentration. No patient in this study developed SOHS, and of course none had to be hospitalized. Vagin al ultrasound performed in the majority of the subjects revealed less- than-or-equal-to 100 ml of peritoneal fluid 48 - 72 h after oocyte ret rieval. The only complication from the use of intravenous albumin was the appearance of a 'flu-like condition' (low grade temperature, nause a and muscle pains) developed by 12 women between days 3 and 5 after o ocyte collection. Intravenous albumin had thus prevented the developme nt of severe ovarian hyperstimulation syndrome in an assisted reproduc tion programme. Its use could allow the maintenance of treatment in pa tients that otherwise would have been cancelled due to their high risk of developing this condition. The proposed mechanisms of action inclu de increase in plasma oncotic pressure, and in the sex steroid binding capacity of the plasma. Both factors could prevent leakage of fluid f rom the intravascular space into the peritoneal cavity.