Incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders after gonadotropin-releasing hormone (GnRH) agonist trigger in "freeze-all" approach.
Fernández-Sánchez. M M; Fatemi. H H; García-Velasco. J A JA; Heiser. P W PW; Daftary. G S GS; Mannaerts. B B
Key Findings
- 22% of high‑responding women got mild OHSS after a GnRH‑agonist trigger
- No severe OHSS or serious adverse events were reported
- Cabergoline was commonly used to keep mild OHSS from worsening
Practical Outcomes
- If you’re using a GnRH‑agonist like triptorelin to trigger egg maturation in a freeze‑all IVF protocol, expect a modest chance of mild OHSS and consider prophylactic cabergoline. The approach appears safe with no severe OHSS, making it a viable option for high responders seeking to avoid stronger ovarian stimulation side effects.
Summary
In women who produce a lot of eggs during IVF, using a GnRH‑agonist shot (triptorelin) to finish egg growth caused mild ovarian hyperstimulation syndrome (OHSS) in about one‑fifth of cases, but no severe cases were seen. The symptoms lasted up to three weeks and were usually managed with cabergoline, a medication that helps prevent the condition from getting worse.
Abstract
To determine the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders (25-35 follicles with a diameter of ≥12 mm on day of triggering) who received a gonadotropin-releasing hormone (GnRH) agonist to trigger final follicular maturation. We used individual data from women who participated in four different clinical trials and were high responders to ovarian stimulation in a GnRH antagonist protocol in this retrospective combined analysis. All women were evaluated for signs and symptoms of OHSS using identical criteria based on Golan's system (1989). High responders (<i>n</i> = 77) were of different ethnicities. There were no differences in baseline characteristics between women with or without signs and symptoms of OHSS. Mean ± standard deviation baseline data were: age, 32.3 ± 3.5 years; anti-Müllerian hormone, 42.4 ± 20.7 pmol/L; antral follicle count, 21.5 ± 9.2. Before triggering, duration of stimulation was 9.5 ± 1.6 days and the mean number of follicles with a diameter of ≥12 mm and ≥17 mm was 26.5 ± 4.4 and 8.8 ± 4.7, respectively. Mean serum estradiol (17,159 pmol/l) and progesterone (5.1 nmol/l) levels were high at 36 h after triggering. Overall, 17/77 high responders (22%) developed signs and symptoms of mild OHSS which lasted 6-21 days. The most frequently prescribed medication was cabergoline to prevent worsening of OHSS. No severe OHSS occurred and no OHSS cases were reported as serious adverse events. High responders receiving GnRH agonist for triggering should be informed that they may experience signs and symptoms of mild OHSS.
Study Information
pubmed
2023
2023-05-08T00:00:00.000Z
10.1080/09513590.2023.2205952
10
38