Predicting and preventing ovarian hyperstimulation syndrome (OHSS): The need for individualized not standardized treatment

Reproductive Biology and Endocrinology

Volumn 10, Issue , 2012, Pages

  Fiedler, Klaus ^a   Ezcurra, Diego ^b  

^a Kinderwunsch Centrum München KCM Fertility Center Munich   (Germany)

^b MERCK SERONO S A   (Switzerland)

Author keywords

Individualized controlled ovarian stimulation; Ovarian hyperstimulation syndrome; Prevention; Risk factors; Vascular endothelial growth factor

Indexed keywords

ALBUMIN; BONE MORPHOGENETIC PROTEIN 15; CABERGOLINE; CHORIONIC GONADOTROPIN; CORIFOLLITROPIN ALFA; DOPAMINE RECEPTOR STIMULATING AGENT; ESTRADIOL; FOLLITROPIN; FOLLITROPIN RECEPTOR; GONADORELIN AGONIST; GUINAGOLIDE; HETASTARCH; LUTEINIZING HORMONE; MESSENGER RNA; METFORMIN; MUELLERIAN INHIBITING FACTOR; UNCLASSIFIED DRUG; VASCULOTROPIN RECEPTOR 2;

AGE; BLOOD VESSEL PERMEABILITY; BODY MASS; BODY WEIGHT; CRYOPRESERVATION; DRUG EFFICACY; EMBRYO TRANSFER; GENE MUTATION; HUMAN; META ANALYSIS (TOPIC); MULTICENTER STUDY (TOPIC); OOCYTE MATURATION; OOCYTE RETRIEVAL; OVARY HYPERSTIMULATION; OVARY POLYCYSTIC DISEASE; OVULATION INDUCTION; PARACENTESIS; PATHOPHYSIOLOGY; PERSONALIZED MEDICINE; PHARMACOGENETICS; PHASE 3 CLINICAL TRIAL (TOPIC); PREDICTION; PREDICTOR VARIABLE; PROTEIN EXPRESSION; PROTEIN FUNCTION; PROTEIN PHOSPHORYLATION; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK FACTOR; SENSITIVITY AND SPECIFICITY; STANDARDIZATION; TRANSVAGINAL ECHOGRAPHY; VITRIFICATION;

CHORIONIC GONADOTROPIN; CRYOPRESERVATION; DOPAMINE AGONISTS; FEMALE; GONADOTROPIN-RELEASING HORMONE; HUMANS; OVARIAN HYPERSTIMULATION SYNDROME; OVULATION INDUCTION; PREGNANCY; PREGNANCY RATE; REPRODUCTIVE TECHNIQUES, ASSISTED; RISK FACTORS;

EID: 84862165308     PISSN: None     EISSN: 14777827     Source Type: Journal    
DOI: 10.1186/1477-7827-10-32     Document Type: Review

References (79)

1. de Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A, . European IVF-monitoring (EIM) Consortium, for the European Society of Human Reproduction and Embryology (ESHRE) Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. Hum Reprod 2010, 25:1851-1862. 10.1093/humrep/deq124, 20570973, European IVF-monitoring (EIM) Consortium, for the European Society of Human Reproduction and Embryology (ESHRE).
2. Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod 2005, 20:3293-3300. 10.1093/humrep/dei253, 16126753.
3. Alper MM, Smith LP, Sills ES. Ovarian hyperstimulation syndrome: current views on pathophysiology, risk factors, prevention, and management. J Exp Clin Assist Reprod 2009, 10:3.
4. Brinsden PR, Wada I, Tan SL, Balen A, Jacobs HS. Diagnosis, prevention and management of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol 1995, 102:767-772. 10.1111/j.1471-0528.1995.tb10840.x, 7547731.
5. Gómez R, Soares SR, Busso C, Garcia-Velasco JA, Simón C, Pellicer A. Physiology and pathology of ovarian hyperstimulation syndrome. Semin Reprod Med 2010, 28:448-457. 10.1055/s-0030-1265670, 21082502.
6. Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet 2010, 27:121-128. 10.1007/s10815-010-9387-6, 2842872, 20140640.
7. Soares SR, Gómez R, Simón C, García-Velasco JA, Pellicer A. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Update 2008, 14:321-333. 10.1093/humupd/dmn008, 18385260.
8. Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update 2003, 9:77-96. 10.1093/humupd/dmg005, 12638783.
9. Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril 1992, 58:249-261.
10. Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril 2010, 94:389-400. 10.1016/j.fertnstert.2010.03.028, 20416867.
11. Papanikolaou EG, Humaidan P, Polyzos NP, Tarlatzis B. Identification of the high-risk patient for ovarian hyperstimulation syndrome. Semin Reprod Med 2010, 28:458-462. 10.1055/s-0030-1265671, 21082503.
12. Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN, Yang YS, Lee MS. Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod 2008, 23:160-167.
13. Kwee J, Elting ME, Schats R, McDonnell J, Lambalk CB. Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization. Reprod Biol Endocrinol 2007, 5:9. 10.1186/1477-7827-5-9, 1847823, 17362511.
14. Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, Van Steirteghem A, Devroey P. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril 2006, 85:112-120. 10.1016/j.fertnstert.2005.07.1292, 16412740.
15. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod 2002, 8:559-577.
16. Enskog A, Henriksson M, Unander M, Nilsson L, Brannstrom M. Prospective study of the clinical and laboratory parameters of patients in whom ovarian hyperstimulation syndrome developed during controlled ovarian hyperstimulation for in vitro fertilization. Fertil Steril 1999, 71:808-814. 10.1016/S0015-0282(99)00090-4, 10231037.
17. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, Stabile G, Volpe A. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update 2010, 16:113-130. 10.1093/humupd/dmp036, 19793843.
18. Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, Laing I. Circulating basal anti-Müllerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril 2009, 92:1586-1593. 10.1016/j.fertnstert.2008.08.127, 18930213.
19. Broer SL, Dólleman M, Opmeer BC, Fauser BC, Mol BW, Broekmans FJ. AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis. Hum Reprod Update 2011, 17:46-54. 10.1093/humupd/dmq034, 20667894.
20. Rizk B. Symposium: Update on prediction and management of OHSS, Genetics of ovarian hyperstimulation syndrome. Reprod Biomed Online 2009, 19:14-27. 10.1016/S1472-6483(10)60041-7, 19573286.
21. Bosch E, Ezcurra D. Individualised controlled ovarian stimulation (iCOS): maximising success rates for assisted reproductive technology patients. Reprod Biol Endocrinol 2011, 9:82. 10.1186/1477-7827-9-82, 3150250, 21693025.
22. Howles CM, Saunders H, Alam V, Engrand P. Predictive factors and a corresponding treatment algorithm for controlled ovarian stimulation in patients treated with recombinant human follicle stimulating hormone (follitropin alfa) during assisted reproduction technology (ART) procedures. An analysis of 1378 patients. Curr Med Res Opin 2006, 22:907-918. 10.1185/030079906X104678, 16709312.
23. Olivennes F, Howles CM, Borini A, Germond M, Trew G, Wikland M, Zegers-Hochschild F, Saunders H, Alam V. Individualizing FSH dose for assisted reproduction using a novel algorithm: the CONSORT study. Reprod Biomed Online 2009, 18:195-204. 10.1016/S1472-6483(10)60256-8, 19192339.
24. Bayly CM, McBain JC, Clarke GA, Gronow MJ, Johnston WI, Martin MJ, Speirs AL. Ovarian stimulation regimens in an in vitro fertilization program: a comparative analysis. Ann N Y Acad Sci 1985, 442:123-127. 10.1111/j.1749-6632.1985.tb37512.x, 3925832.
25. Fiedler K, Ludwig M. Use of clomiphene citrate in in vitro fertilization (IVF) and IVF/intracytoplasmic sperm injection cycles. Fertil Steril 2003, 80:1521-1523. 10.1016/S0015-0282(03)02208-8, 14667897.
26. Yates AP, Rustamov O, Roberts SA, Lim HY, Pemberton PW, Smith A, Nardo LG. Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Obstet Gynecol Survey 2011, 66:760-776.
27. D'Angelo A, Brown J, Amso NN. 2011. Cochrane Database Syst Rev 2011, 6:CD002811.
28. Devroey P, Fauser BC, Platteau P, Beckers NG, Dhont M, Mannaerts BM. Induction of multiple follicular development by a single dose of long-acting recombinant follicle-Stimulating hormone (FSH-CTP, corifollitropin alfa) for controlled ovarian stimulation before in vitro fertilization. J Clin Endocrinol Metab 2004, 89:2062-2070. 10.1210/jc.2003-031766, 15126522.
29. Fauser BC, Alper MM, Ledger W, Schoolcraft WB, Zandvliet A, Mannaerts BM. Engage Investigators: Pharmacokinetics and follicular dynamics of corifollitropin alfa versus recombinant FSH during ovarian stimulation for IVF. Reprod Biomed Online 2010, 21:593-601. 10.1016/j.rbmo.2010.06.032, 20843746.
30. The corifollitropin alfa Ensure Study Group Corifollitropin alfa for ovarian stimulation in IVF: a randomized trial in lower-body-weight women. Reprod Biomed Online 2010, 21:66-76. The corifollitropin alfa Ensure Study Group.
31. Devroey P, Boostanfar R, Koper NP, Mannaerts BM, Ijzerman-Boon PC, Fauser BC, . ENGAGE Investigators A double-blind, non-inferiority RCT comparing corifollitropin alfa and recombinant FSH during the first seven days of ovarian stimulation using a GnRH antagonist protocol. Hum Reprod 2009, 24:3063-3072. 10.1093/humrep/dep291, 2777786, 19684043, ENGAGE Investigators.
32. Norman RJ, Zegers-Hochschild F, Salle BS, Elbers J, Heijnen E, Marintcheva-Petrova M, Mannaerts B. Trust Investigators: Repeated ovarian stimulation with corifollitropin alfa in patients in a GnRH antagonist protocol: no concern for immunogenicity. Hum Reprod 2011, 26:2200-2208. 10.1093/humrep/der163, 3137390, 21622693.
33. Costello MF, Chapman M, Conway U. A systematic review and meta-analysis of randomized controlled trials on metformin co-administration during gonadotrophin ovulation induction or IVF in women with polycystic ovary syndrome. Hum Reprod 2006, 21:1387-1399. 10.1093/humrep/dei501, 16449310.
34. Lim K, Lee W, Lim J. IVM after interruption of COH for the prevention of OHSS. Fertil Steril 2005, 84:S84-S85.
35. Abdallah R, Kligman I, Davis O, Rosenwaks Z. Withholding gonadotropins until human chorionic gonadotropin administration. Semin Reprod Med 2010, 28:486-492. 10.1055/s-0030-1265675, 21082507.
36. Levinsohn-Tavor O, Friedler S, Schachter M, Raziel A, Strassburger D, Ron-El R. Coasting-what is the best formula?. Hum Reprod 2003, 18:937-940. 10.1093/humrep/deg230, 12721165.
37. Tozer AJ, Iles RK, Iammarrone E, Gillott CM, Al-Shawaf T, Grudzinskas JG. The effects of 'coasting' on follicular fluid concentrations of vascular endothelial growth factor in women at risk of developing ovarian hyperstimulation syndrome. Hum Reprod 2004, 19:522-528. 10.1093/humrep/deh096, 14998945.
38. García-Velasco JA, Zúñiga A, Pacheco A, Gómez R, Simón C, Remohí J, Pellicer A. Coasting acts through downregulation of VEGF gene expression and protein secretion. Hum Reprod 2004, 19:1530-1538. 10.1093/humrep/deh298, 15155606.
39. Mansour R, Aboulghar M, Serour G, Amin Y, Abou-Setta AM. Criteria of a successful coasting protocol for the prevention of severe ovarian hyperstimulation syndrome. Hum Reprod 2005, 20:3167-3172. 10.1093/humrep/dei180, 16006465.
40. Delvigne A, Rozenberg S. A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients. Hum Reprod Update 2002, 8:269-291.
41. Kashyap S, Parker K, Cedars MI, Rosenwaks Z. Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose. Semin Reprod Med 2010, 28:475-485. 10.1055/s-0030-1265674, 21082506.
42. Youssef MA, Al-Inany HG, Aboulghar M, Mansour R, Abou-Setta AM. Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles. Cochrane Database Syst Rev 2011b, 4:CD003719.
43. van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M. Luteal phase support for assisted reproduction cycles.Cochrane.Database. Syst. Rev 2011, 10:CD009154.
44. Youssef MA, van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, van der Veen F. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update 2010, 16:459-466. 10.1093/humupd/dmq006, 20354100.
45. Tehraninejad ES, Hafezi M, Arabipoor A, Aziminekoo E, Chehrazi M, Bahmanabadi A. Comparison of cabergoline and intravenous albumin in the prevention of ovarian hyperstimulation syndrome: a randomized clinical trial. J Assist Reprod Genet 2010, 29:259-264.
46. Carizza C, Abdelmassih V, Abdelmassih S, Ravizzini P, Salgueiro L, Salgueiro PT, Jine LT, Nagy P, Abdelmassih R. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reprod Biomed Online 2008, 17:751-755. 10.1016/S1472-6483(10)60401-4, 19079957.
47. Gomez R, Ferrero H, Gado-Rosas F, Gaytan M, Morales C, Zimmermann RC, Simon C, Gaytan F, Pellicer A. Evidences for the existence of a low dopaminergic tone in polycystic ovarian syndrome: implications for OHSS development and treatment. J Clin Endocrinol Metab 2011, 96:2484-2492. 10.1210/jc.2011-0075, 21646367.
48. Itskovitz J, Boldes R, Barlev A, Erlik Y, Kahana L, Brandes JM. The induction of LH surge and oocyte maturization by GnRH analogue (buserelin) in women undergoing ovarian stimulation for in vitro fertilization. Gynecol Endocrinol 1988, 2(Suppl 2):165.
49. Humaidan P, Kol S, Papanikolaou E, . on behalf of the 'The Copenhagen GnRH Agonist Triggering Workshop Group' GnRH agonist for triggering of final oocyte maturation: time for a change of practice?. Hum Reprod Update 2011, 17:510-524. 10.1093/humupd/dmr008, 21450755, on behalf of the 'The Copenhagen GnRH Agonist Triggering Workshop Group'.
50. Engmann L, Benadiva C. Ovarian hyperstimulation syndrome prevention strategies: Luteal support strategies to optimize pregnancy success in cycles with gonadotropin-releasing hormone agonist ovulatory trigger. Semin Reprod Med 2010, 28:506-512. 10.1055/s-0030-1265678, 21082510.
51. Kol S, Itskovitz-Eldor J. Gonadotropin-releasing hormone agonist trigger: the way to eliminate ovarian hyperstimulation syndrome -a 20-year experience. Semin Reprod Med 2010, 28:500-505. 10.1055/s-0030-1265677, 21082509.
52. Youssef MA, Van der Veen F, Al-Inany HG, Griesinger G, Mochtar MH, van Wely M. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database Syst Rev 2011, 1:CD008046.
53. Youssef MA, Al-Inany HG, Evers JL, Aboulghar M. Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2011a, 2:CD001302.
54. Aboulghar M, Evers JH, Al-Inany H. Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review. Hum Reprod 2002, 17:3027-3032. 10.1093/humrep/17.12.3027, 12456597.
55. Jee BC, Suh CS, Kim YB, Kim SH, Choi YM, Kim JG, Moon SY. Administration of intravenous albumin around the time of oocyte retrieval reduces pregnancy rate without preventing ovarian hyperstimulation syndrome: a systematic review and meta-analysis. Gynecol Obstet Invest 2010, 70:47-54. 10.1159/000286379, 20173327.
56. Gokmen O, Ugur M, Ekin M, Keles G, Turan C, Oral H. Intravenous albumin versus hydroxyethyl starch for the prevention of ovarian hyperstimulation in an in-vitro fertilization programme: a prospective randomized placebo controlled study. Eur J Obstet Gynecol Reprod Biol 2001, 96:187-192. 10.1016/S0301-2115(00)00452-8, 11384805.
57. Herrero L, Martínez M, Garcia-Velasco JA. Current status of human oocyte and embryo cryopreservation. Curr Opin Obstet Gynecol 2011, 23:245-250.
58. Sills ES, McLoughlin LJ, Genton MG, Walsh DJ, Coull GD, Walsh AP. Ovarian hyperstimulation syndrome and prophylactic human embryo cryopreservation: analysis of reproductive outcome following thawed embryo transfer. J Ovarian Res 2008, 1:7. 10.1186/1757-2215-1-7, 2585559, 19014420.
59. Fitzmaurice GJ, Boylan C, McClure N. Are pregnancy rates compromised following embryo freezing to prevent OHSS?. Ulster Med J 2008, 77:164-167. 2604472, 18956797.
60. Gera PS, Tatpati LL, Allemand MC, Wentworth MA, Coddington CC. Ovarian hyperstimulation syndrome: steps to maximize success and minimize effect for assisted reproductive outcome. Fertil Steril 2010, 94:173-178. 10.1016/j.fertnstert.2009.02.049, 19356753.
61. Queenan JT, Veeck LL, Toner JP, Oehninger S, Muasher SJ. Cryopreservation of all prezygotes in patients at risk of severe hyperstimulation does not eliminate the syndrome, but the chances of pregnancy are excellent with subsequent frozen-thaw transfers. Hum Reprod 1997, 12:1573-1576. 10.1093/humrep/12.7.1573, 9262299.
62. Ferraretti AP, Gianaroli L, Magli C, Fortini D, Selman HA, Feliciani E. Elective cryopreservation of all pronucleate embryos in women at risk of ovarian hyperstimulation syndrome: efficiency and safety. Hum Reprod 1999, 14:1457-1460. 10.1093/humrep/14.6.1457, 10357958.
63. D'Angelo A. Ovarian hyperstimulation syndrome prevention strategies: cryopreservation of all embryos. Semin Reprod Med 2010, 28:513-518. 10.1055/s-0030-1265679, 21082511.
64. Braat DD, Schutte JM, Bernardus RE, Mooij TM, van Leeuwen FE. Maternal death related to IVF in the Netherlands 1984-2008. Hum Reprod 2010, 25:1782-1786. 10.1093/humrep/deq080, 20488805.
65. Busso CE, Garcia-Velasco JA, Simon C, Pellicer A. Prevention of OHSS: Current strategies and new insights. Middle East Fertil Soc J 2010, 15:223-230.
66. Selman H, Brusco GF, Fiorini F, Barnocchi N, Mariani M, El-Danasouri I. Vitrification is a highly efficient method to cryopreserve human embryos in in vitro fertilization patients at high risk of developing ovarian hyperstimulation syndrome. Fertil Steril 2009, 91(4 Suppl):1611-1613.
67. Zhu D, Zhang J, Cao S, Zhang J, Heng BC, Huang M, Ling X, Duan T, Tong GQ. Vitrified-warmed blastocyst transfer cycles yield higher pregnancy and implantation rates compared with fresh blastocyst transfer cycles-time for a new embryo transfer strategy?. Fertil Steril 2011, 95:1691-1695. 10.1016/j.fertnstert.2011.01.022, 21315339.
68. Al-Hasani S, Ozmen B, Koutlaki N, Schoepper B, Diedrich K, Schultze-Mosgau A. Three years of routine vitrification of human zygotes: is it still fair to advocate slow-rate freezing?. Reprod Biomed Online 2007, 14:288-293. 10.1016/S1472-6483(10)60869-3, 17359578.
69. Aboulghar M. Treatment of ovarian hyperstimulation syndrome. Semin Reprod Med 2010, 28:532. 10.1055/s-0030-1265681, 21082512.
70. Shrivastav P, Nadkarni P, Craft I. Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity. Hum Reprod 1994, 9:812-814.
71. Smith LP, Hacker MR, Alper MM. Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis. Fertil Steril 2009, 92:1953-1959. 10.1016/j.fertnstert.2008.09.011, 18976762.
72. Fluker MR, Copeland JE, Yuzpe AA. An ounce of prevention: outpatient management of the ovarian hyperstimulation syndrome. Fertil Steril 2000, 73:821-824. 10.1016/S0015-0282(99)00606-8, 10731547.
73. Lincoln SR, Opsahl MS, Blauer KL, Black SH, Schulman JD. Aggressive outpatient treatment of ovarian hyperstimulation syndrome with ascites using transvaginal culdocentesis and intravenous albumin minimizes hospitalization. J Assist Reprod Genet 2002, 19:159-163. 10.1023/A:1014828027282, 12036082.
74. Csokmay JM, Yauger BJ, Henne MB, Armstrong AY, Queenan JT, Segars JH. Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: "tap early and often" versus hospitalization. Fertil Steril 2010, 93:167-173. 10.1016/j.fertnstert.2008.09.054, 18990389.
75. Grossman LC, Michalakis KG, Browne H, Payson MD, Segars JH. The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome. Fertil Steril 2010, 94:1392-1398. 10.1016/j.fertnstert.2009.07.1662, 3124341, 19836016.
76. Aboulghar MA, Mansour RT, Serour GI, Sattar MA, Amin YM, Elattar I. Management of severe ovarian hyperstimulation syndrome by ascitic fluid aspiration and intensive intravenous fluid therapy. Obstet Gynecol 1993, 81:108-111.
77. Ovarian stimulation 2011, 123. Cambridge University Press, Cambridge, Aboulghar M, Rizk B.
78. Fluker MR, Copeland JE, Yuzpe AA. An ounce of prevention: outpatient management of the ovarian hyperstimulation syndrome. Fertil Steril 2000, 73:821-824. 10.1016/S0015-0282(99)00606-8, 10731547.
79. Shmorgun D, Claman P. The diagnosis and management of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can 2011, 11:1156-1162.