Journal of Assisted Reproduction and Genetics, Vol. 19, No. 4, April 2002 ( C  2002) Clinical Assisted Reproduction Aggressive Outpatient Treatment of Ovarian Hyperstimulation Syndrome With Ascites Using Transvaginal Culdocentesis and Intravenous Albumin Minimizes Hospitalization 1 Stephen R. Lincoln, 2,3 Michael S. Opsahl, 2 Keith L. Blauer, 2 Susan H. Black, 2 and Joseph D. Schulman 2 Submitted July 9, 2001; accepted November 19, 2001 Purpose : To assess the effectiveness of outpatient treatment of Ovarian Hyperstimulation Syndrome associated with ascites. Methods : Forty-eight patients diagnosed with ovarian hyperstimulation and ascites from 2246 consecutive in vitro fertilization cycles were retrospectively studied. Patients were treated with outpatient transvaginal culdocentesis and rehydration with intravenous crystalloids and albu- min every 1–3 days until resolution of symptoms or hospitalization was required. Outcomes measured included incidences of hospitalization, pregnancy outcomes, cycle characteristics, and oocyte donors versus nondonors comparisons. Results : No complications occurred from outpatient treatments, and 91.6% of patients avoided hospitalization. The pregnancy rate in patients undergoing transfer was 84.7%, and the spon- taneous loss rate was 16%. Overall, the estradiol on day of hCG was 4331 pg/mL (range 2211–8167), ascites removed was 1910 cm 3 (122–4000), and number of outpatient treatments was 3.4 (1–14). Nondonors averaged more outpatient treatments than donors (3.97 vs. 1.85), but similar rates of hospitalization (3/35 vs. 1/13). Conclusions : Outpatient treatment consisting of culdocentesis, intravenous rehydration, and albumin minimized the need for hospitalization in hyperstimulated patients. KEY WORDS: Albumin; culdocentesis; ovarian hyperstimulation syndrome. INTRODUCTION Ovarian Hyperstimulation Syndrome (OHSS) is a potentially lethal iatrogenic complication of ovula- tion induction with gonadotropin therapy. The inci- dence of severe OHSS is estimated to be between 0.5 and 1.8% (1–3). Severe OHSS is characterized 1 Presented at the 56th Annual Meeting of the American Society for Reproductive Medicine, San Diego, California, October 21–25, 2000. 2 Genetics and IVF Institute, 3020 Javier Road, Fairfax, Virginia 22031. 3 To whom correspondence should be addressed. by an increased capillary permeability resulting in a transudate fluid shift out of the intravascular com- partment into third space compartments (4,5). Severe disease can be associated with ovarian enlarge- ment, massive ascites, hydrothorax, hemoconcentra- tion, electrolyte imbalance, hypovolemia, oliguria, and thromboembolic phenomenon (2,3,6). Severe clinical manifestations may include acute renal insuf- ficiency, adult respiratory distress syndrome, liver dys- function, and even death (7). Treatment of severe OHSS includes bed rest, oral balanced salt solutions, intravenous fluid therapy, and removal of ascites (7–10) in an effort to prevent criti- cal end organ failure associated with renal shutdown 159 1058-0468/02/0400-0159/0 C  2002 Plenum Publishing Corporation