No room for cancellation, coasting, or ovarian hyperstimulation syndrome in oocyte donation cycles

Gonadotropin-releasing hormone agonists versus antagonists for controlled ovarian hyperstimulation in oocyte donors: a systematic review and meta-analysis

“…It has been suggested that the choice of the triggering agent is directly related to the reduction in OHSS incidence in the antagonist arm (24). Recent trials (8)(9)(10) demonstrated extensively the elimination of the syndrome in oocyte donors after GnRH agonist triggering. Moreover recent RCTs (11)(12)(13) also showed similar outcome in terms of oocyte maturation, fertilization rates, and recipient pregnancy rates after substituting hCG with a GnRH agonist for inducing final oocyte maturation in GnRH antagonist protocols.…”

“…Moreover, several recent retrospective studies (8)(9)(10) and randomized clinical trials (RCTs) (11)(12)(13) performed in oocyte donors showed a significantly reduced OHSS incidence when a GnRH agonist was used for inducing final oocyte maturation instead of hCG. Because triggering of ovulation with GnRH agonists is only feasible in GnRH antagonist-based protocols, the choice of the most adequate GnRH analogue for donor stimulation protocols is a clinically important question.…”

Early ovarian hyperstimulation syndrome is completely prevented by gonadotropin releasing-hormone agonist triggering in high-risk oocyte donor cycles: a prospective, luteal-phase follow-up study

“…In addition to increased donor safety, the clinical management of oocyte donor cycles is also profoundly influenced. Cycle monitoring becomes much easier (reducing or even eliminating the need for hormonal assays), and interventions for OHSS prevention (coasting or cycle cancellation) are no longer necessary (5). It must be pointed out, however, that in a few patients (6% to 7%) some milder symptoms are still present and this is probably related to oocyte retrieval and/or a high ovarian response.…”

“…Two randomized controlled trials with high-risk IVF patients (1,2) confirmed the absence of moderate/severe OHSS and implantation rates seemed not to be affected by the use of vigorous luteal support. In the context of oocyte donation, the reduction in OHSS incidence was demonstrated both by retrospective series (3)(4)(5) as well as randomized clinical trials (6,7). Our group has published the largest experience (4,7) to date with GnRH-agonist triggered oocyte donor cycles.…”

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

“…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 .…”