Combined modalities for the prevention of ovarian hyperstimulation syndrome following an excessive response to stimulation

Abstract

Although the classification and management of ovarian hyperstimulation syndrome (OHSS) are well described in the literature, little attention has been given to modalities that aim to prevent its occurrence. In this retrospective study, we sought to investigate whether a combination of modalities in addition to GnRH agonist triggering in GnRH antagonist cycles could result in better prevention of OHSS. The study included 170 hyperresponder patients who were stimulated with GnRH antagonist protocol and were triggered with GnRH agonist for final oocyte maturation. Freeze all embryos was performed in all patients. The intervention group included treatment with dopamine agonist and restarting the GnRH antagonist. Of the 170 patients included, 63 were included in the intervention group. Compared to no intervention, women in the intervention group were more likely to have: menses within 7 days of the oocyte retrieval, smaller ovarian diameter, the absence of free pelvic fluid, less hemoconcentration and higher serum sodium levels. It can be concluded that combining other modalities in addition to triggering with GnRH agonist in GnRH antagonist cycles, results in targeting several pathways that lead to OHSS and result in rapid resolution of signs of ovarian hyperstimulation.

Chinese abstract

尽管在文献中对卵巢过度刺激综合征 (OHSS)的分级和处理有详细的描述, 然而, 人们很少注意到那些旨在预防其发生的模式。在这项回顾性的研究中, 我们试图评估在GnRH拮抗剂周期中除GnRH激动剂诱发外, 联合方案是否会对过度刺激产生更好的预防效果。这项研究包括170位高反应者, 他们接受GnRH拮抗剂方案, 并且由GnRH激动剂诱发最终的卵母细胞成熟。所有病人的全部胚胎, 都会被冷冻。干预组使用多巴胺激动剂治疗, 并重新启动GnRH拮抗剂治疗。在这170名患者中, 干预组包含63人。与对照组相比, 干预组的女性更有可能的情况是:在取卵术的7天内行经, 卵巢直径更小, 缺少盆腔积液, 血液浓缩水平更低, 血清钠水平更高。由此可以得出结论, 在GnRH拮抗剂周期中除GnRH激动剂诱发外, 联合其他模式可以针对引起卵巢过度刺激的几种途径快速解决卵巢过度刺激的症状。

Keywords:

• Ovarian hyperstimulation syndrome
• prevention
• dopamine agonist
• GnRH antagonist
• GnRH agonist

Disclosure statement

The authors declare that they have no conflict of interests to declare and that funding was not received for performing the study.