Role of Albumin and Furosemide Combination for Decreasing the Incidence of Severe Ovarian Hyperstimulation Syndrome in Hyper-responders undergoing ICSI Cycles: A Randomized Controlled Trial

Abstract

Background: Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of controlled ovarian stimulation during in vitro fertilization (IVF). Several preventive strategies have been proposed to reduce its incidence and severity. Objectives: To evaluate the efficacy of prophylactic albumin combined with furosemide in women at high risk of OHSS undergoing IVF/ICSI (Intracytoplasmic Sperm Injection). Materials and methods: This randomized controlled trial was conducted on 200 infertile women undergoing IVF/ICSI and embryo transfer who were identified as being at high risk for developing OHSS. Eligible participants were recruited according to predetermined risk factors for OHSS and were randomly allocated to Group A, which received prophylactic albumin infusion (on the day of oocyte retrieval and the day of the embryo transfer) along with furosemide (100 patients in total), and Group B, in which this prophylactic regimen was not given. They were subsequently followed up to determine the incidence and severity of OHSS and to evaluate the effectiveness of this combined prophylactic regimen in preventing OHSS. Results: The incidence of severe OHSS was significantly lower in the intervention group (A) than in the control group (B). Likewise, the cycle cancellation (freeze-all) rate was significantly reduced. No significant differences were observed in clinical pregnancy, miscarriage, or live birth rates between the two groups. Conclusion: Prophylactic albumin combined with furosemide significantly reduced the incidence of severe OHSS and cycle cancellation without adversely affecting reproductive outcomes. Larger multicenter randomized trials are warranted to confirm these findings.