An OHSS-Free Clinic by segmentation of IVF treatment

Abstract

Published data indicate a significant increase in ovarian hyperstimulation syndrome globally. The occurrence of approximately three maternal deaths per 100,000 stimulated women has been reported, and extrapolation of these figures to a global situation would give an impressive number. The syndrome can be erased by applying ovarian stimulation using the combination of GnRH antagonist with GnRH agonist to trigger ovulation. In this case, the strategy is to freeze all of the oocytes or embryos for later use.

Ovarian hyperstimulation syndrome after gonadotropin-releasing hormone agonist triggering and “freeze-all”: in-depth analysis of genetic predisposition

“…However, OHSS still occurs in current clinical practice [14] and its overall importance increases with the steady worldwide proliferation of IVF. GnRH agonist ovulation triggering has contributed to the further reduction of severe OHSS [37,10,15,14] and, in conjunction with elective cryopreservation of all viable embryos, is considered to be the safest way to avoid OHSS after OS for IVF [38,12,14]. In view of this, elective cryopreservation of embryos has been proposed for women undergoing IVF/ICSI who develop ≥18 follicles with a diameter of at least 10-14 mm [39] to minimize the risk of the development of severe OHSS.…”

“…In a GnRH antagonist co-treated cycle, the GnRH agonist causes the displacement of the GnRH antagonist from the pituitary receptors, resulting in a LH flare-up/Bsurget hat lasts for approximately 24-36 h [7]. This approach, combined with the elective cryopreservation of all oocytes/embryos, referred to by some as the BOHSS-free clinic^ [14], had effectively abolished the incidence of severe early OHSS [14,15,10] until recently, when the first cases of OHSS requiring hospitalization were reported [16][17][18][19]. These cases include both patients with either grade 4 (3 cases) and grade 5 (4 patients) severe early-onset OHSS according to the OHSS classification proposed by Golan et al [adopted by the European Society of Human Reproduction and Embryology (ESHRE)] [20].…”

Agonist depot versus OCP programming of frozen embryo transfer: a retrospective analysis of freeze-all cycles

“…Concomitantly, significant improvements have been made to cryopreservation technology, resulting in improved freeze-thaw outcomes from FET [1,2]. The resultant confidence in FET has encouraged ART centers to more readily consider routine cohort cryopreservation [3,4]. The rationale to use so-called segmented-ART treatment has been the avoidance of iatrogenic complications related to controlled ovarian stimulation (COS), such as, ovarian hyperstimulation syndrome (OHSS) and premature progesterone rise [3,5].…”

The state of “freeze-for-all” in human ARTs

“…For these patients, the combination of the right stimulation protocol and the vitrification of oocytes/embryos have transformed what was a high-risk situation into an anecdotic one [70,71]. As described by Devroey et al [72], the strategy to obtain OHSSfree clinics is closely related to the segmentation concept. It consists of the following: segment A, stimulation with GnRH antagonist and triggering with GnRH agonist; segment B, optimum cryopreservation of oocytes or embryos through vitrification; and segment C, embryo replacement into a receptive, non stimulated endometrium in a natural cycle or with artificial endometrial preparation.…”