Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis

Objective: To describe our experience with aggressive outpatient transvaginal paracentesis to manage ovarian hyperstimulation syndrome (OHSS). Design: Retrospective case series. Setting: Private, academically affiliated IVF center. Patient(s): Women undergoing assisted reproductive technologies (ART) and having a diagnosis of OHSS. Intervention(s): Management of OHSS with hospitalization or outpatient transvaginal paracentesis between 1999 and 2007. Main Outcome Measure(s): Grade and stage of OHSS, need for hospitalization, and adverse events. Result(s): From 1999 to 2007, we identified 183 patients with OHSS. We began performing outpatient transvaginal paracentesis to treat OHSS in 2002. We have performed 146 outpatient transvaginal paracenteses in 96 patients with no procedure-related complications. With the implementation of early, aggressive, outpatient paracentesis, the number of patients requiring hospitalization for OHSS decreased. From 2006 to 2007, 29 patients were diagnosed with severe OHSS and 25 (86%) were managed as outpatients with transvaginal paracentesis with no complications. Conclusion(s): This report represents one of the largest series of patients with OHSS managed with outpatient transvaginal paracentesis. Although there continues to be a small percentage of patients with OHSS who require hospitalization, the vast majority of patients with severe OHSS at our center in the past 2 years had their condition successfully managed as outpatients with use of aggressive transvaginal paracentesis. (Fertil Steril (R) 2009;92:1953-9. (C)2009 by American Society for Reproductive Medicine.)