Clinicians mustremain alertto the possibility ofOHSS in all women undergoing fertility treatment and
women should be counselled accordingly. [New 2016]
Diagnosis of OHSS
How is OHSS diagnosed and what differential diagnoses should be considered?
Clinicians need to be aware of the symptoms and signs of OHSS, as the diagnosis is based on clinical
criteria.
In women presenting with severe abdominal pain or pyrexia, extra care should be taken to rule out
other causes of the patient’s symptoms. The input of clinicians experienced in the management of
OHSS should be obtained in such cases. [New 2016]
Assessing severity and reporting adverse outcomes
How is the severity of OHSS classified?
The severity of OHSS should be graded according to a standardised classification scheme.
How should OHSS be reported?
Licensed centres should comply withHuman Fertilisation and Embryology Authority (HFEA)regulations
in reporting cases of severe or critical OHSS among their patients.
Units that treat women with OHSS should inform the licensed centre where the fertility treatment was
carried outto promote clinical continuity and to allow the licensed centre to meetits legal obligations.
Organisation of services
How should care be delivered for women at risk of OHSS?
Fertility clinics should provide verbal and written information concerning OHSS to all women
undergoing fertility treatment, including a 24-hour contact telephone number.
All acute units where women with suspected OHSS are likely to present should establish agreed local
protocols for the assessment and management of these women and ensure they have access to
appropriately skilled clinicians with experience in the management of this condition.
Initial assessment
How should women suspected of suffering from OHSS be assessed?
Women presenting with symptoms suggestive of OHSS should be assessed face-to-face by a clinician
if there is any doubt about the diagnosis or if the severity is likely to be greater than mild. [New 2016]
Outpatient management of OHSS
Which patients with OHSS are suitable for outpatient care?
Outpatient management is appropriate for women with mild or moderate OHSS and in selected cases
with severe OHSS.
What management is appropriate in the outpatient setting for patients with OHSS?
Women undergoing outpatient management ofOHSS should be appropriately counselled and provided
with information regarding fluid intake and output monitoring. In addition, they should be provided
with contact details to access advice.
Nonsteroidal anti-inflammatory agents should be avoided, as they may compromise renal function.
Women with severe OHSS being managed on an outpatient basis should receive thromboprophylaxis
with low molecular weight heparin (LMWH). The duration of treatment should be individualised,
taking into account risk factors and whether or not conception occurs.
Paracentesis of ascitic fluid may be carried out on an outpatient basis by the abdominal ortransvaginal
route under ultrasound guidance.
There is insufficient evidence to support the use of gonadotrophin-releasing hormone antagonists or
dopamine agonists in treating established OHSS. [New 2016]
How should women with OHSS managed on an outpatient basis be monitored?
Women withOHSS being managed on an outpatient basis should be reviewed urgently ifthey develop
symptoms or signs of worsening OHSS (see Section 9.3). In the absence of these, review every
2–3 days is likely to be adequate. [New 2016]
Baseline laboratory investigations should be repeated if the severity of OHSS is thought to be
worsening. Haematocrit is a useful guide to the degree of intravascular volume depletion. [New 2016]