Ovarian Hyperstimulation Syndrome after GnRH Agonist Triggering and Freeze-All Protocol? Never Not, Hardly Ever: A Systematic Review of Case Reports.

Abstract

INTRODUCTION:

Ovarian hyperstimulation syndrome (OHSS) is a severe complication associated with controlled ovarian stimulation (COS). GnRH agonist (GnRH-a) triggering is considered an efficient strategy to prevent OHSS in the high-risk patient.

METHODS:

We performed a review of 11 cases of early and severe OHSS following GnRH-a triggering and freeze-all protocol. Electronic databases were searched from inception of each database until October 2021, to identify case reports and case series that reported OHSS after GnRH-a triggering and freeze-all approach describing patient demographics, COS protocol, and patient outcomes.

RESULTS:

From the literature review, it is possible to suggest that (1) following GnRH-a triggering, the risk of early and severe OHSS is not totally cancelled; (2) despite it is not possible to predict the event, polycystic ovary syndrome is the most common risk factor; (3) the use of GnRH antagonist starting from the day of PU may represent a valid strategy for preventing OHSS in women with high-risk profile; (4) following the unexpected onset of OHSS, measuring serum levels of human chorionic gonadotropin (hCG) is helpful to exclude an inadvertent exogenous administration or a pregnancy.

CONCLUSION:

The statement that OHSS risk is eliminated when GnRH-a triggering, a freeze-all strategy, and no hCG in the luteal phase may generate the idea that this event cannot occur. Although rare, these cases have been observed in a relatively short period of time.

• Authors: Giuseppe Gabriele Iorio, Luigi Carbone, Alessandro Conforti, Marika Ylenia Rovetto, Silvia Picarelli, Federica Cariati, Ida Strina, Evangelos Papanikolaou, Carlo Alviggi
• Journal: Gynecologic and obstetric investigation (Gynecol Obstet Invest) Vol. 87 Issue 5 Pg. 259-265 ( 2022) ISSN: 1423-002X [Electronic] Switzerland
• PMID: 36070703 (Publication Type: Case Reports, Systematic Review)
• Copyright: © 2022 S. Karger AG, Basel.

Chemical References

• Gonadotropin-Releasing Hormone
• Chorionic Gonadotropin

Topics

• Pregnancy
• Female
• Humans
• Ovarian Hyperstimulation Syndrome (chemically induced, prevention & control)
• Ovulation Induction (adverse effects, methods)
• Gonadotropin-Releasing Hormone
• Fertilization in Vitro (adverse effects, methods)
• Chorionic Gonadotropin (adverse effects)