CLINICAL REPORT: The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome

Previous experiences in subjects with other forms of third spacefluid accumulation have shown that albumin is efficacious inpreventing and correcting haemodynamic instability. Using asimilar approach in an effort to increase the serum oncoticpressure and to reverse the leakage of fluids from the intravascularspace, high risk subjects for severe ovarian hyperstimulationsyndrome (SOHS) were treated with albumin. In a recent largestudy two high risk factors were identified, i.e. the numberof oocytes and levels of serum oestradiol. Thirty-six womenundergoing assisted reproductive techniques who presented boththese factors, received intravenous albumin at a dose of 5%in Ringers lactate in doses of 500 ml during oocyte retrievaland 500 ml immediately thereafter in the recovery room. Dailymeasurements of urine output, serum and urine electrolytes,weight, abdominal girth, and haematocrit prior to and afteroocyte retrieval revealed normal serum and urine electrolytelevels, and no signs of haemoconcentration. No patient in thisstudy developed SOHS, and of course none had to be hospitalized.Vaginal ultrasound performed in the majority of the subjectsrevealed 100 ml of peritoneal fluid 48–72 h after oocyteretrieval. The only complication from the use of intravenousalbumin was the appearance of a ‘flu-like condition’(low grade temperature, nausea and muscle pains) developed by12 women between days 3 and 5 after oocyte collection. Intravenousalbumin had thus prevented the development of severe ovarianhyperstimulation syndrome in an assisted reproduction programme.Its use could allow the maintenance of treatment in patientsthat otherwise would have been cancelled due to their high riskof developing this condition. The proposed mechanisms of actioninclude increase in plasma oncotic pressure, and in the sexsteroid binding capacity of the plasma. Both factors could preventleakage of fluid from the intravascular space into the peritonealcavity.