To reevaluate ovarian hyperstimulation syndrome (OHSS) prevention techniques and provide
a classification system for grading OHSS and evidence-based treatment strategies for
preventing OHSS.
A literature search was conducted in PubMed for articles published in the last 5 years
using the keywords "controlled ovarian stimulation," "controlled ovarian hyperstimulation,"
"ovarian hyperstimulation syndrome," "OHSS," "prevention," "chorionic gonadotropin,"
"hCG," "GnRH agonist," "GnRH antagonist," "coasting," and "cryopreservation." We reviewed
randomized controlled trials (RCTs), retrospective studies, pilot studies, case studies,
reviews, and meta-analyses.
There is a shortage of large, prospective RCTs reporting OHSS prediction and prevention
strategies. Our review showed that risk factors such as antral follicle count and
baseline anti-Müllerian hormone level may identify women at high OHSS risk. Preventative
strategies that appear highly effective at reducing or preventing OHSS include GnRH
antagonist protocols and the use of GnRH agonists to trigger final oocyte maturation.
Moreover, alternative therapies, such as dopamine receptor agonists (Cabergoline),
have also emerged as potential new treatment modalities in the management of this
disease.
These findings suggest that current treatment guidelines should be updated to incorporate
findings from recent literature that show that GnRH antagonist protocols consistently
reduce OHSS and that GnRH agonist triggering has considerable promise in preventing
OHSS, although further RCTs will be needed to confirm this.
Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc.
All rights reserved.