Gonadotropin-Releasing Hormone (GnRH) Agonist Trigger in a GnRH Antagonist Protocol and Severe Ovarian Hyperstimulation Syndrome.
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Date
2015
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Abstract
Aims: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life-threatening
complication of ovarian stimulation. The best strategy to prevent it is to use a gonadotropinreleasing
hormone (GnRH) agonist (GnRHa) to trigger final oocyte maturation in a GnRH
antagonist protocol, followed by cryopreservation of all oocytes/embryos (freeze-all strategy). The
objective of this study is to describe two cases of a rare occurrence of severe OHSS following
GnRHa trigger in a GnRH antagonist protocol and freeze-all strategy.
Presentation of Case: Two patients (a 33-year-old patient, and a 31-year old patient) were
submitted to in vitro fertilization (IVF). The ovarian stimulation started on day 2 of her menstrual
cycle in a step-down GnRH antagonist protocol. The final oocyte maturation was induced with a
bolus of 0.2 mg triptorelin in both cases. Due tothe risk of OHSS, all the embryos were cryopreserved and no embryo transfer was performed. In the case 1, two days after oocyte
retrieval, the patient was seen at the emergency and was diagnosed with severe OHSS with
bilateral pleural effusion. In the case 2, three days after oocyte retrieval, the patient was seen at
the emergency unit and was diagnosed with severe OHSS. Both patients were managed in an
intensive care unit.
Conclusions: Unless the substitution of human chorionic gonadotropin (hCG) by GnRHa
triggering in antagonist cycles is done in combination with no embryo transfer (which is the best
form of OHSS prevention), and unless it virtually completely eliminates the onset of OHSS, this
complication may still occur in certain groups of patients.
Description
Keywords
GnRH agonist trigger, ovarian hyperstimulation syndrome, OHSS, freeze all
Citation
Roque Matheus, Valle Marcello, Sampaio Marcos, Geber Selmo. Gonadotropin-Releasing Hormone (GnRH) Agonist Trigger in a GnRH Antagonist Protocol and Severe Ovarian Hyperstimulation Syndrome. British Journal of Medicine and Medical Research. 2015; 5(9): 1188-1192.