Why does protein help ohss

Its role as a carrier protein enables it to bind and inactivate the vasoactive intermediate released in OHSS patients. Albumin has also got colloid osmotic properties which maintain IV volume and prevent the effects of hypovolemia, ascites and hemoconcentration. Asch et al 10 were the first to administer IV human albumin 50 g on the day of ovum retrieval in order to prevent OHSS in high-risk patients. According to this study, none of the 36 treated women developed severe OHSS. Of note, 21 of these women did not undergo embryo transfer, thus eliminating the risk of severe OHSS.

A study conducted by Bellver et al, 1 included both patients and oocyte donors; the subjects were divided into control group and IV albumin group. Baseline assessment was performed at oocyte retrieval and 7 days later hyperstimulated assessment was done. There was no significant difference noted between the albumin and control groups.

Hence, they conferred that albumin does not improve the evolution of high-risk cases. IV albumin administration around the time of oocyte retrieval appeared to reduce the risk of severe OHSS in high-risk cases.

However, he suggested that further study is necessary to optimize the dosage and timing of administration. A meta-analysis done by Venetis et al, 5 concluded that prophylactic IV albumin administration following ovarian stimulation for IVF does not appear to reduce the occurrence of severe OHSS in high-risk patients. Soliman 6 compared the effect of cabergoline with IV albumin and combination of both for the prevention of the early onset OHSS.

It was evident that administration of cabergoline along with IV albumin is more effective than the administration of albumin alone.

Orvieto et al 11 revealed that 16 out of patients treated with conventional IV albumin developed OHSS, in comparison with 26 of patients in the control group. This was not statistically significant. Hence, albumin was ineffective against late severe OHSS. One more case series submitted by Lewit et al, 12 concurred that the administration of IV albumin could have contributed to reducing the level of severity of the syndrome.

But, it is far from acting as either a cure or a preventive measure for OHSS. Cambiaghi et al 13 assessed the effect of oral whey protein for preventing OHSS. The study revealed that there was no difference between the two groups in terms of patient characteristics, but the duration of OHSS was lower in Group II than in Group I. The study concluded that the use of whey protein to prevent OHSS in high-risk patients may serve as a potential alternative, especially to avoid severe forms.

Our study also revealed similar findings in the incidence of OHSS between the two groups. However, since there are no randomized studies yet to authenticate the use of natural protein diet in OHSS patients, further research is needed to elaborate and conclude our results. This study exhibits that the oral intake of natural protein diet acts better in preventing the severe form of OHSS than the administration of IV albumin in high-risk cases.

Patients consuming natural protein diet incurred less expenditure, duration of hospital stay, reduced complications of OHSS and emotional stress as compared to patients on parenteral albumin.

However, a more randomized study is necessary to validate the role of protein diet in the patients who are suspected to develop OHSS. Sign In Individual Sign In. Toggle navigation. Current Issue Archives Subscribe. Clinical Study. Abstract Aim: To compare the effectiveness of natural protein diet and intravenous IV albumin in the management of ovarian hyperstimulation syndrome OHSS.

Keywords: Ovarian hyperstimulation syndrome, IV albumin, polycystic ovarian syndrome, natural protein diet The assisted reproduction technology ART is a rapidly advancing field, where clinical practices and laboratory techniques are regularly revised, validated and updated. However, 0. Management of severe OHSS includes daily monitoring of fluid intake and output volume, abdominal girth, weight gain, leukocyte count, hematocrit, and electrolytes.

Thromboprophylaxis should be initiated by starting subcutaneous heparin units daily twice. Routine conservative measures were instituted and patient was put under intensive care. Due to development of pleural effusion and ascitis, the patient complained of dyspnoea, hence pleural tapping followed by abdominal paracentesis was done to relieve the respiratory symptoms. In view of drop in serum albumin levels, intravenous albumin was given.

However, after three doses, patient developed severe reaction to albumin, precluding its further usage. However, due to rapid collection of ascitic fluid and consequent development of dyspnea, frequent paracentesis was resorted to ameliorate the symptoms. This lead to further fall in albumin levels and with oral high protein intake proving to be highly inadequate, alternative means of albumin replacement became imperative. Inputs from medical oncologists were taken regarding usage of thawed plasma in such clinical conditions where rapid albumin replacement was required.

It served the dual purpose of rapid albumin replacement and volume expander. We decided to use it after weighing its risks and benefits due to continued deterioration in the patient's condition and lack of viable alternatives to reverse the trend.

Dramatic improvement in the patient's clinical condition with increased urine output and no further increase in ascitic fluid were noted. The serum albumin level also increased by approximately 0. No further paracentesis was required and the patient was discharged and followed up on outpatient basis. Unfortunately, it turned out to be a non-viable pregnancy which was terminated.

Thawed plasma differs from thawed fresh frozen plasma in having lower amount of certain coagulation factors such as factor V and VIII. Usage of thawed plasma for volume expansion and albumin replacement is not among the recommended indications. However, such worries are there even with intravenous albumin.

Theoretically speaking, a more rapid replacement of albumin using thawed plasma may help resolve the pathology earlier precluding the need for termination of pregnancy. However, we need to further evaluate our findings before advocating such measures. Although rare, the case highlights a dilemma faced by infertility specialists while treating critical OHSS. When the duration of OHSS gets unduly prolonged and few commonly used therapeutic measures do not bring any improvement in the patient's condition, drastic measure like termination of pregnancy remain the only practical option with the clinician.

Laparotomy and bilateral partial oophrectomy has been suggested as another aggressive step short of termination of pregnancy. Further studies are needed to establish the role of thawed plasma as a therapeutic alternative in severe OHSS. Source of Support: Nil.

Conflict of Interest: None declared. If patients develop uncomfortable ascites with more severe OHSS, a transvaginal culdocentesis can be performed in the office. We do this similar to an egg retrieval but instead of withdrawing follicular fluid, we can drain ascites fluid from the posterior cul-de-sac under ultrasound guidance. Patients typically have significant symptom relief after this procedure. When a culdocentesis is performed, often 1. Since patients can present intravascularly deplete with hyponatremia, normal saline should be the fluid of choice.

Albumin riders can also be added to their Intravenous fluids. When hemo-concentration is encountered, enoxaparin and baby Aspirin can be started. For patients who have risk factors for OHSS, we can plan treatment protocols to decrease their risk. One option is to lower their dose of gonadotropins to keep their estrogen levels in a lower range. Another main strategy is to change the type of trigger we are using.

This technique is incredibly useful because patients do not develop OHSS, but does have some pitfalls:. Anti-Nausea Medication Although it is very important to eat small frequent meals with high levels of protein, if you are experiencing nausea you likely will not have a big appetite. Pain Management Although pain can can act as a natural way for our bodies to communicate injury, having uncontrollable pain can greatly effect your quality of life.

Stool Softeners for Constipation The opiate anasthetics as well as progesterone usually cause constipation which can be relieved by incorporated stool softeners like colace, senokot, prune juice, and even magnesium supplements.

Light Physical Activity to Decrease Blood Clots and Swelling Although strenuous physical activity and sexual intercourse should be avoided as risk of ovarian torsion increases when the ovaries are enlarged, light physical activity can help decrease the chances of blood clots and has an added benefit of decreasing swelling. Share Tweet Pin it Share.

Female Infertility , Male Infertility , Webinar. Female Infertility , Male Infertility. Female Infertility. A Glossary of Fertility Terms and Acronyms.

Explore Path. Stay In Touch. Privacy Settings. We use cookies to enhance your experience while using our website. If you are using our Services via a browser you can restrict, block or remove cookies through your web browser settings. We also use content and scripts from third parties that may use tracking technologies. You can selectively provide your consent below to allow such third party embeds. For complete information about the cookies we use, data we collect and how we process them, please check our Privacy Policy.

To learn more about the cookies we use and the data we collect, please check our Privacy Policy. I Accept. Cart Overview.