Ovarian Hyperstimulation Syndrome Medication

  • Author: Joanna Horwitz, MD; Chief Editor: Richard Scott Lucidi, MD   more...
 
Updated: Mar 23, 2012
 

Medication Summary

Medical therapy is aimed at the correction of fluid and electrolyte balance.

Thrombosis can occur in the arteries (25%) and veins (75%). Therefore, use of heparin, low molecular weight heparin (enoxaparin sodium [Lovenox]), antiembolism stockings, and sequential compression devices (boots) are all recommended as prophylaxis against thrombosis. Heparin prophylaxis is usually started in patients with a history of thrombosis, factor V Leiden deficiency, or other thrombophilic states before the induction of ovulation.

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Anticoagulant

Class Summary

These agents inhibit key factors involved in thrombogenesis.

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Heparin

 

Augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse but can inhibit further thrombogenesis. Prevents reaccumulation of clot after spontaneous fibrinolysis.

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Electrolyte supplement, parenteral

Class Summary

Used to replenish intravascular and extravascular volume.

Normal saline

 

Used to restore interstitial and intravascular volume.

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Blood product derivatives

Class Summary

These agents are used to expand plasma volume.

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Albumin (Albuminar, Albumisol, Albunex, Albutein, Buminate)

 

Major plasma protein responsible for colloid oncotic pressure of blood. Pooled from blood, serum, plasma, or placenta from healthy donors. Given in certain types of shock or impending shock. Use 5% solution to expand plasma volume and maintain cardiac output. Use 25% solution to raise oncotic pressure.

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Adrenergic agonist agent

Class Summary

These agents increase blood pressure.

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Dopamine (Intropin)

 

Naturally occurring endogenous catecholamine that stimulates beta1-adrenergic, alpha1-adrenergic, and dopaminergic receptors in dose-dependent fashion; stimulates release of norepinephrine.

At low dosages (2-5 mcg/kg/min), acts on dopaminergic receptors in renal and splanchnic vascular beds, causing vasodilation-selective dilation of renal vasculature, enhancing renal perfusion. Also reduces sodium absorption, decreasing energy requirement of damaged tubules. This enhances urine flow, which, in turn, helps prevent tubular cast obstruction. Most clinical studies have failed to establish this beneficial role of renal-dose dopamine infusion.

At midrange dosages (5-15 mcg/kg/min), acts on beta-adrenergic receptors to increase heart rate and contractility.

At high dosages (15-20 mcg/kg/min), acts on alpha-adrenergic receptors to increase systemic vascular resistance and raise blood pressure.

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Contributor Information and Disclosures
Author

Joanna Horwitz, MD  Staff Physician, Department of Obstetrics and Gynecology, Loyola University Medical Center

Joanna Horwitz, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ramesh S Pundi, MD  Attending Physician, Department of Obstetrics and Gynecology, Genesis Health System, Davenport, Iowa

Ramesh S Pundi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Indian Medical Association

Disclosure: Nothing to disclose.

Josef Blankstein, MD  Chairman, Department of Obstetrics and Gynecology, Rosalind Franklin University of Health Sciences, Chicago Medical School

Josef Blankstein, MD is a member of the following medical societies: Academy of Medicine Cleveland/Northern Ohio Medical Assn, American College of Obstetricians and Gynecologists, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne R Trupin, MD, FACOG  Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center

Suzanne R Trupin, MD, FACOG is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michel E Rivlin, MD  Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD  Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

For their industrious work in collecting articles and research, Estello Escudero, MA LibSc, Mt Sinai Hospital Library, and Merly Arceo, BA LibSc, Mt Sinai Hospital; and, for his unstinting support and encouragement, Dr Jos Blankstein.

References

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  8. Insler V, Lunenfeld B. Pathogenesis of ovarian hyperstimulation syndrome. In: Gomel V, Leung PCK. In Vitro Fertilization and Assisted Reproduction. Bologna, Italy: Monduzzi Editore; 1997:433-9.

  9. Abramov Y, Elchalal U, Schenker JG. Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril. Apr 1999;71(4):645-51. [Medline].

  10. Polishuk WZ, Schenker JG. Ovarian overstimulation syndrome. Fertil Steril. May-Jun 1969;20(3):443-50. [Medline].

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  17. Levin ER, Rosen GF, Cassidenti DL, et al. Role of vascular endothelial cell growth factor in Ovarian Hyperstimulation Syndrome. J Clin Invest. Dec 1 1998;102(11):1978-85. [Medline].

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  19. Wang TH, Horng SG, Chang CL, et al. Human chorionic gonadotropin-induced ovarian hyperstimulation syndrome is associated with up-regulation of vascular endothelial growth factor. J Clin Endocrinol Metab. Jul 2002;87(7):3300-8. [Medline].

  20. Blankstein J, Lunenfeld S, Mashiach S. Introduction of Ovulation and In Vitro Fertilization. Chicago, Ill: YearBook Medical; 1986.

  21. Levin I, Almog B, Avni A, et al. Effect of paracentesis of ascitic fluids on urinary output and blood indices in patients with severe ovarian hyperstimulation syndrome. Fertil Steril. May 2002;77(5):986-8. [Medline].

  22. Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. Aug 1992;58(2):249-61. [Medline].

  23. Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. Feb 15 2012;2:CD008605. [Medline].

  24. Herman A, Raziel A, Strassburger D, et al. The benefits of mid-luteal addition of human chorionic gonadotrophin in in-vitro fertilization using a down-regulation protocol and luteal support with progesterone. Hum Reprod. Jul 1996;11(7):1552-7. [Medline].

  25. Lunenfeld B, Insler V, Glezerman M. Diagnosis and Treatment of Functional Infertility. 3rd ed. Berlin, Germany: Blackwell Wissenschaft; 1993:98.

 
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Ultrasonographic presentation of ovarian hyperstimulation syndrome.
 
 
 
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