Department of Obstetrics and Gynecology, Jichi Medical School, Minamikawachi-machi, Tochigi 32904, Japan
Dear Sir,
I read with great interest the paper on i.v. albumin in the prevention of severe ovarian hyperstimulation syndrome (OHSS) (Orvieto and Ben-Rafael, 1998). Prophylactic administration of albumin for severe OHSS was initially introduced in 1993 (Asch et al., 1993
), and supportive studies have subsequently been reported (Shalev, 1998
). Therefore we have been evaluating the efficacy of albumin to prevent severe OHSS since 1996.
In our institute, 20 oocytes were retrieved from 98 patients at high risk of severe OHSS between January 1996 and September 1997. The oestradiol in their serum was not measured. The patients were prospectively divided into two groups based on the presence or absence of the administration of albumin as a prophylaxis. Randomization was performed with use of a random-number table. All patients gave informed consent to participate. A total of 43 patients were administered electrolyte solution 1000 ml per day plus albumin 37.5 g per day, for 3 consecutive days from the day of oocyte retrieval (group A). A total of 55 patients were administered sole electrolyte solution 1000 ml per day for 3 consecutive days from the day of oocyte retrieval (group B). Gamete intra-fallopian transfer (GIFT), in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed in all patients. Furthermore, all subjects underwent embryo (gamete) transfer. The incidence of severe OHSS was compared in both groups to evaluate the efficacy of i.v. albumin in the primary prevention (Orvieto and Ben-Rafael, 1998
) of severe OHSS. In this study, severe OHSS was defined by the presence of marked haemoconcentration (haematocrit
45%) and/or hypoproteinaemia (serum total protein <6.0 g/dl) in addition to marked ascites on the upper abdomen at least 4 days after oocyte retrieval. Early and late OHSS were defined as previously described (Orvieto and Ben-Rafael, 1998
). The protocols of ovarian stimulation and luteal support were the same in both groups (Sayama et al., 1996)
).
The profiles and outcomes of both groups are shown in Table I. The incidence of severe OHSS was slightly lower in group A (30.2%) than in group B (38.1%). The frequency of the occurrence of early severe OHSS was similar in both groups (25.6% in group A and 27.3% in group B respectively). Late severe OHSS occurred slightly less frequently in group A (4.7%) compared with that in group B (10.9%). In patients who subsequently exhibited severe OHSS, i.v. albumin supplementation and restriction of water intake were used as the main protocol. Although some patients (five patients in group A and 11 patients in group B) required additional therapy (paracentesis, anticoagulant and dopamine), all patients recovered without critical conditions.
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In conclusion, we surmise that the efficacy of i.v. albumin in the primary prevention of severe OHSS is limited.
Notes
1 To whom correspondence should be addressed
References
Asch, R.H., Ivery, G., Goldsman, M. et al. (1993) The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum. Reprod., 8, 10151020.[Abstract]
Orvieto, R. and Ben-Rafael, Z. (1998) Role of intravenous albumin in the prevention of severe ovarian hyperstimulation syndrome. Hum. Reprod., 13, 33063309.
Sayama, M., Araki, S., Motoyama, M. et al. (1996) The clinical efficacy of gamete intrafallopian transfer by minilaparotomy versus in vitro fertilization and embryo transfer. J. Obstet. Gynaecol. Res., 22, 409416.[Medline]
Shalev, E. (1998) The role of intravenous albumin in the prevention of ovarian hyperstimulation syndrome. In Filicori, M. and Flamigni, C. (eds), Ovulation Induction Update `98. Parthenon Press, London, UK, 177 pp.