A recent review provides clinical guidelines which may help prevent ovarian hyperstimulation syndrome
Two hormones may be used to activate oocyte maturation: human chorionic gonadotropin (hCG), which is the standard treatment, and gonadotropin-releasing hormone agonist (GnRH-A). The problem is that in a very low percentage of patients (3-4%), the administration of hCG may cause ovarian hyperstimulation syndrome (OHSS), and although GnRH-A minimises the risk of OHSS, it causes luteal phase deficiency and achieves poorer implantation and higher miscarriage rates unless additional hormone therapy is administered.
For this reason, Dr. Carlos Dosouto, an expert in gynaecological endocrinology at Dexeus Women's Health in Barcelona, and Dr. Peter Humaidan, associate professor at the University of Aarhus and Director of Skive Fertility Clinic (Denmark) reviewed the effectiveness of GnRH agonists as an alternative to standard treatment based on the results observed in the scientific literature over the last 12 years, as well as the utility of the implementation of various strategies with the aim of offering some clinical recommendations.
The authors concluded that in the majority of patients, the concomitant administration of a gonadotropin-releasing hormone agonist (GnRH-A) and additional hormone therapy to promote implantation during the luteal phase in fresh cycles significantly reduces the risk of onset of OHSS. In addition, in patients with a high risk of OHSS, it is advisable to segment treatment by prior freezing of oocytes, which also achieves good results while minimising the risk of OHSS (0.1%). For this reason, the authors suggest that the use of a GnRH agonist is likely to become the method of choice in future IVF treatments. The results of the analysis were recently published in Reproductive Biology.
Gonadotropin-releasing hormone agonist (GnRHa) trigger - State of the art
Dosouto C, Haahr T, Humaidan P.
Reprod Biol. 2017 Mar;17(1):1-8. doi: 10.1016/j.repbio.2017.01.004. Epub 2017 Feb 16.