Severe ovarian hyperstimulation syndrome after gonadotropin-releasing hormone (GnRH) agonist trigger and “freeze-all” approach in GnRH antagonist protocol (original) (raw)
2014, Fertility and Sterility
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This paper presents two cases of severe ovarian hyperstimulation syndrome (OHSS) occurring after the administration of a GnRH agonist trigger within a GnRH antagonist protocol, in the absence of hCG for luteal-phase support. The study highlights potential genetic factors, including FSH receptor mutations, that may predispose individuals to OHSS. Findings advocate for further research into the relationship between receptor mutations and the frequency and severity of OHSS, emphasizing that a freeze-all approach may not entirely mitigate OHSS risk.
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Gynecological Endocrinology, 2018
Objective: The aim of this work was to investigate the value of laparoscopic ovarian drilling (LOD) compared with GnRH antagonist flexible protocol combined with cabergoline (Cb), as a prophylaxis against the redevelopment of ovarian hyperstimulation syndrome (OHSS) in women with clomiphene citrateresistant polycystic ovary disease (CCR-PCOD) who had severe OHSS before in a previous ICSI cycle. Study design: It is a prospective controlled study, where 250 CCR-PCOD women (n ¼ 250) with a history of severe OHSS before, had been recruited for the study. LOD had been performed for 120 (n ¼ 120) of the recruited women before ovarian induction, and considered as group A. GnRH antagonist (Cetrotide 0.25 mg) was added when a leading follicle reaches 14-16 mm combined with oral Cb in a dose 0.5 mg a day before hCG, and for 8 d for another 130 (n ¼ 130) women, and considered as group B. Pregnancy was diagnosed with BhCG level !25 IU/L, ± 14 d after embryo transfer, followed with transvaginal ultrasound scanning (TVS) 2 weeks later to confirm intra-uterine pregnancy (IUP). Women were followed up weekly for 3 months for the possible development of any signs and symptoms of OHSS. Results: None of the participants in group A developed severe OHSS, and only six women (5%) developed mild to moderate OHSS. The incidence of severe OHSS was significantly higher (n ¼ 3, 15%) in group B compared with group A (p < .001). Another (n ¼ 17, 13.3%) women in group B developed mild to moderate OHSS. The probability of developing severe OHSS was also significantly higher in group B as well (p ¼ .031). Pregnancy rate (PR) was significantly higher in group A more than group B (67% versus 39%, respectively), and all were single intrauterine pregnancies (IUP) and all developed after fresh embryo transfer (ET), compared with frozen embryo transfer (FET) which was performed in 42 cases in group B after postponing ET due to significantly severe OHSS developed. Conclusion: LOD could be considered a good prophylactic measure against OHSS, in addition to improving the total outcome of IVF cycles in women with CCR-PCOS.
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