Interventions for the prevention of OHSS in ART cycles: an overview of Cochrane reviews

Forty years of IVF

“…The aim should be to titrate the stimulation dose in such a way that the optimal number of follicles develop. Too few follicles (also referred to as low response) usually means poor IVF outcome, whereas too many developing follicles induce a risk for developing the potentially hazardous OHSS (412). When assessing the optimal number of oocytes, next to pregnancy rates, other important features associated with ovarian stimulation should also be considered such as cost, burden of treatment and risks.…”

Gonadotropin levels at the start of ovarian stimulation predict normal fertilization after hCG re‐trigger in GnRH antagonist cycles

“…The most possible pathogenesis of OHSS is the increased release of vascular endothelial growth factor (VEGF) by human chorionic gonadotropin (hCG) administered as an ovulation trigger in COS protocols, which induces capillary hyperpermeability 4‐7 . Although the reported incidence of OHSS in in vitro fertilization (IVF) cycles varies widely, mild OHSS and moderate‐to‐severe OHSS are expected to occur in 20%‐33% and 3%‐8%, respectively, of IVF cycles 8 . In order to prevent OHSS, GnRH antagonist protocols using a GnRH agonist (GnRHa) as an ovulation trigger have been introduced in IVF cycles 9 .…”

“…[4][5][6][7] Although the reported incidence of OHSS in in vitro fertilization (IVF) cycles varies widely, mild OHSS and moderate-to-severe OHSS are expected to occur in 20%-33% and 3%-8%, respectively, of IVF cycles. 8 In order to prevent OHSS, GnRH antagonist protocols using a GnRH agonist (GnRHa) as an ovulation trigger have been introduced in IVF cycles. 9 GnRH antagonist protocols, as compared with conventional GnRHa long protocols, require a lower dose of gonadotropin medications 10 and reduce the risk of serious OHSS.…”

Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment

“…Consequently, early OHSS is regarded as predominantly trigger‐related, whereas late OHSS is regarded as predominantly pregnancy‐related. Cryopreservation of embryos with transfer in later cycles (segmentation) can be used to manage the risk of OHSS, although logically, segmentation can only mitigate the occurrence of late OHSS . The risk of early OHSS can more reliably be mitigated using alternative triggers of oocyte maturation to hCG.…”

“…Cryopreservation of embryos with transfer in later cycles (segmentation) can be used to manage the risk of OHSS, although logically, segmentation can only mitigate the occurrence of late OHSS. 5 The risk of early OHSS can more reliably be mitigated using alternative triggers of oocyte maturation to hCG. Even so, 20% of IVF cycles started in Europe 6 and 28% of IVF cycles conducted in the US 7 necessitated segmentation to mitigate the risk of late OHSS.…”