What Is the Treatment of Ovarian Hyperstimulation Syndrome?
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation. Evidence-based management targets risk reduction through deliberate choices made at each stage of the stimulation cycle — from how the protocol is designed to how oocyte maturation is triggered and how the resulting cycle is managed.
Treatment approach
The structured protocol centres on protocol-level risk-reduction strategies — including the choice of stimulation regimen and the approach to gonadotropin dosing — with further interventions applied at the time of trigger and in decisions about subsequent cycle management; the complete regimen and decision algorithm are in the full protocol.
References
DOI: 10.1016/j.fertnstert.2023.11.013
- It is recommended to employ ovarian stimulation protocols using GnRH antagonists over protocols using GnRH agonists when there is concern for OHSS.
- It is recommended to dose gonadotropins based on individualized ovarian reserve testing to decrease the risk of OHSS.
- 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.
- 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.
- It is recommended to add adequate luteal support if using a GnRH agonist for trigger and planning a fresh embryo transfer.
- 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.
- 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.
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