Management of ovarian hyperstimulation following ovulation induction with buserelin and human menopausal gonadotrophin

Summary

Two women were scheduled to undergo in vitro fertilisation and embryo transfer (IVF-ET) following pituitary suppression with buserelin, a GnRH analogue, and ovarian stimulation with human menopausal gonadotrophin (hMG). The first woman displayed symptoms of ovarian hyperstimulation syndrome on the day of embryo transfer, resulting in the procedure being cancelled and the embryos being frozen. After 3 months and in a subsequent cycle, eight embryos were thawed, three replaced and the woman became pregnant. The second woman had a high serum oestradiol concentration and large number of follicles greater than 14 mm in diameter on the day of ovulatory trigger. The patient was further down regulated' and ovarian stimulation started again with a lower dose of hMG. This resulted in two embryos being replaced and eventual pregnancy. The relative merits of embryo freezing for transfer in a subsequent cycle, and continued down regulation with a second period of ovarian stimulation as two methods for limiting the symptoms of ovarian hyperstimulation in IVF cycles are discussed.