Ascites and liver test abnormalities during severe ovarian hyperstimulation syndrome

OBJECTIVE: Severe ovarian hyperstimulation syndrome is an uncommon cause of ascites that is being increasingly recognized because of the high number o f women undergoing assisted reproductive techniques, mainly in vitro fertil ization. This prospective study investigates the clinical and biochemical c haracteristics of a large series of patients with this syndrome and ascites , including renal and electrolyte abnormalities, activity of neurohormonal systems participating in the regulation of extracellular fluid volume, and liver function tests. METHODS: This was a prospective longitudinal study including 50 consecutive patients with ascites due to severe ovarian hyperstimulation syndrome. Ren al function, serum electrolytes, body weight, mean arterial pressure, pulse rate, plasma renin activity. plasma concentration of aldosterone, norepine phrine, antidiuretic hormone and atrial natriuretic peptide, and standard l iver function tests were measured during the syndrome and 4-5 wk after reco very. A sample of ascitic fluid was obtained from eight patients for protei n measurement and cell count. RESULTS: At diagnosis, patients had ascites associated with low urinary sod ium excretion, oliguria, and hyponatremia. They had also markedly low arter ial pressure and increased pulse rate in association with marked activation of vasoconstrictor and antinatriuretic factors. The ascitic fluid was char acterized by a high protein concentration, low leukocyte count. and relativ ely high number of red blood cells. Fifteen (30%) patients had abnormal liv er tests characterized by mild to moderate increases in AST (mean 103 +/- 1 7.1 IU/L) and ALT (76 +/- 8.3 IU/L), which were associated in some cases wi th increases in gamma-glutamyl transpeptidase or alkaline phosphatase. All abnormalities reverted to normal after the resolution of the syndrome. CONCLUSIONS: With the increasing use of assisted reproductive techniques, p hysicians should be aware of severe ovarian hyperstimulation syndrome as a cause of ascites. The syndrome is associated with sodium retention, hyponat remia. arterial hypotension, and marked activation of vasoconstrictor and a ntinatriuretic systems. In one third of patients, liver tests abnormalities an present. (C) 1999 by Am. Cell. of Gastroenterology).