Febrile morbidity in severe and critical ovarian hyperstimulation syndrome: a multicentre study

The objective of this study was to define the incidence of febrilemorbidity and its causes in severe and critical ovarian hyperstimulationsyndrome (OHSS). For this purpose, we reviewed the medical records of allOHSS patients hospitalized in 16 out of 19 tertiary medical centres inIsrael between January 1987 and December 1996. Febrile morbidity wasdefined as at least one episode of temperature rise above 38 degrees Clasting > or =24 h. A total of 2902 patients (3305 hospitalizations)with OHSS was identified, of whom 196 had severe, and 13 critical, OHSS.Among the 209 patients investigated the incidence of febrile morbidity was82.3%, of which 20.5% was attributed to urinary tract infection, 3.8% topneumonia, 3.3% to upper respiratory tract infection, 2.0% to intravenousline phlebitis, 1.0% to cellulitis at an abdominal puncture site, 1.0% topostoperative wound infections and 0.5 % to gluteal abscess at the site ofprogesterone injection. Non-typical organisms were frequently isolated,such as Pseudomonas, Proteus, Klebsiella and Enterobacter species. Noinfectious aetiology was found in 105 patients (50.2%). Hypoglobulinaemiawas recorded in most patients, while ascitic and pleural fluids aspiratedfrom these patients contained high globulin concentrations. We concludethat infection-related febrile morbidity in severe and critical OHSS ishigh, and may be attributed to some degree of immunodeficiency associatedwith loss of plasma globulins to the third space. However,non-infection-related febrile morbidity is even higher and may beattributed to endogenous pyrogenic mechanisms.