This document discusses strategies for preventing ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) treatment. It proposes individualizing treatment based on factors like a patient's anti-Mullerian hormone (AMH) level and follicle count. Protocols discussed include using a gonadotropin-releasing hormone (GnRH) agonist or antagonist, adjusting the timing and type of ovulation trigger, and providing luteal phase support. Studies are cited showing comparable pregnancy outcomes between protocols while reducing OHSS risk through techniques like freeze-all embryo cycles or vitrification of surplus embryos.
2. Ovarian Hyperstimulation syndrome (OHSS)
is a complication characterized from retention
of fluid, abdominal ascites, abdominal pain
Severe cases need hospitalization
In extreme scenario might turn into fatal
Prevalence of 2-10%
(Papanikolaou and Devroey, 2006, Hum Reprod)
4. Antagonist vs. Agonist Protocol
Papanikolaou E.G. et al. in preparation 2013
Agonist
Homogenised
recruitment
Doctor
friendly
Endome
triosis
Antagonist
Less
OHSS
Indivi
duali
zation
Patient
friendly
5. Bourgain et al., ESHRE Prague, June 20th, 2006
Results: Endometrial Biopsies, progesterone and pregnancy
outcome
0
5
10
n
pregnant not pregnant
proliferative
D2
D3
D4
polyp
endometritis
P dHCG mean (SD) 0.95(0.24) 1.15(0.54) p<0.3
P dOPU mean (SD) 10.2(5.57) 11.98(5.64) p<0.4
P µg/L
6. Luteal phaseDay of ovulation triggering
Follicular
phase
GnRH Agonist
Triggering
(0.2mg Triptorelin,
0.5mg Buserelin,
1mg Leuprolide)
Supplement luteal phase
1500 IU uhCG on OPU
or Luteal LH 300IU/2nd day
or im. Progesterone+E2
Single embryo
Transfer
(vitrify surplus)
Freeze all embryos
2PN or Day-2/3
Freeze half embryos on day-2/3
and culture the rest to Day-5
Single Blastocyst
transfer
(vitrify if surplus)
New Algorithm for OHSS prevention
Papanikolaou et al., RBE, 2012
