Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study

Griesinger, G.; Otte, Sebastian; Schröer, Andreas; Ludwig, A. K.; Diedrich, K.; Al‐Hasani, S.; Schultze-Mosgau, A.

doi:10.1093/humrep/dem006

Cited by 122 publications

(62 citation statements)

References 32 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Santos‐Ribeiro

Polyzos

Stouffs

et al. 2015

J Assist Reprod Genet

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Purpose We report on the results of the whole-genome analysis performed in a patient who developed severe ovarian hyperstimulation syndrome (OHSS) following gonadotropinreleasing hormone (GnRH) agonist triggering in a Bfreeze-allp rotocol.Methods A 30-year-old patient with polycystic ovary syndrome who developed severe early-onset OHSS with clinical ascites, and slight renal and hepatic dysfunction was admitted for monitoring and treatment with cabergoline and intravenous albumin. Exome sequencing to assess for any known genetic predisposition for OHSS was performed.Results No known genetic variants associated with OHSS predisposition were found. Conclusions Case reports of severe OHSS following a Bfreeze-all^strategy are starting to arise, showing that OHSS has not been completely eliminated with this approach. Further studies should be conducted to confirm if such cases may be due to genetic predisposition or not.

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Section: Discussionmentioning

confidence: 99%

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

Santos‐Ribeiro

Polyzos

Stouffs

et al. 2015

J Assist Reprod Genet

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“…Consequently, the combination of an agonist trigger with elective cryopreservation of all embryos is now recognised as being highly effective at reducing the risk of OHSS [23].…”

Section: Avoid Exogenous and Endogenous Hcg Exposurementioning

confidence: 99%

Prevention and management of ovarian hyperstimulation syndrome

Nelson

2017

Thrombosis Research

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Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of ovarian stimulation. It is feasible to identify patients at risk, modify stimulation strategies to ameliorate risk, and initiate out-patient treatments that alter disease pathophysiology to reduce disease severity. Mitigation of OHSS risk and severity, through innovative approaches prior to treatment, during treatment and after treatment should now be the standard care. This review summarizes recent developments and provides recommendations on the prevention and treatment of OHSS.3

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“…Th e criteria for GnRH agonist triggering for the patients at high risk of OHSS characterized by a high number of follicles (>12) measuring ≥12 mm and/or high serum E2 levels (≥4000 pg/mL) have been suggested 18 . According to results from several studies in the last decade in OHSS high risk patients, the GnRH agonist for ovulation triggering signifi cantly reduces or almost elimi nates the incidence of OHSS and therefore GnRH agonist trigger is the best tool for OHSS prevention 3,[22][23][24] . GnRH agonist triggering is a valid alternative to hCG triggering, resulting in elimination of OHSS and no other pre vention strategy comes close to this result 25 .…”

Section: Gnrh Agonistsmentioning

confidence: 99%

“…Furthermore, there was no evidence indicating that minimal stimulation regimens diff ered signifi cantly from gonadotropins in GnRH agonist protocols in terms of OHSS incidence and live births or pregnancy rates. According to fi ndings from a Cochrane analysis, the use of CC with gonadotropins (with or without mid-cycle antagonist) led to a reduction in the incidence of OHSS varying between 0.8% and 1.8%, compared with 3.5% preva- Casper et al 12 Engmann et al 14 Gülekli et al 16 Humaidan et al 21 Griesenger et al 22 Fatemi et al 45 Tang et al 47 Leitao et al 48 Youssef et al 49 Alvarez et al 50 Busso et al 51 Baumgarten et al Nastri et al 8 Zarek et al 55 Rinaldi et al 56 Casano et al 57 Gibrel et al 58 Figueiredo et al 59 Mild ovarian response Less drug use and lower cost Lower incidence of OHSS Satisfactory pregnancy rates and pregnancy outcome…”

Section: Mild Stimulation Protocolsmentioning

confidence: 99%

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

Kasum

Orešković

Franulić

et al. 2017

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SUMMARY -Th e purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitro fertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely eff ective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols off er attractive option in OHSS prevention with satisfactory pregnancy rates.

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Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study

Abstract: The present study is the proof of the concept that GnRH-agonist triggering of final oocyte maturation in combination with elective cryopreservation of 2 PN oocytes offers OHSS risk patients a good chance of pregnancy achievement, while reducing the risk of moderate and severe OHSS.

Cited by 122 publications

References 32 publications

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

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

Prevention and management of ovarian hyperstimulation syndrome

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

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