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References

DOI: 10.1016/j.fertnstert.2023.11.013

1. It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS.
2. It is recommended to dose gonadotropins based on individualized ovarian reserve testing to decrease the risk of OHSS.
3. It is recommended to consider lowering the starting dose of gonadotropins and/or supplementing with oral ovulation-inducing medications (clomiphene citrate and/or letrozole) to decrease the risk of OHSS.
4. It is recommended to use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce the risk of moderate-to-severe OHSS.
5. It is recommended to add adequate luteal support if using a GnRH agonist for trigger and planning a fresh embryo transfer.
6. In patients at risk for moderate-to-severe OHSS, it is recommended to start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon thereafter and continue for several days.
7. It is recommended to consider a freeze-only cycle and subsequent frozen embryo transfer in patients at risk for OHSS on the basis of a high ovarian response or elevated serum estradiol levels.