Ovarian hyperstimulation syndrome prevention strategies: Luteal support strategies to optimize pregnancy success in cycles with gonadotropin-releasing hormone agonist ovulatory trigger

Abstract

Gonadotropin-releasing hormone agonist (GnRHa) administration for the induction of oocyte maturation during in vitro fertilization treatment is effective in the prevention of ovarian hyperstimulation syndrome (OHSS). However, some studies have reported a lower ongoing pregnancy rate after GnRHa trigger. The excellent conception rates reported in recipients receiving embryos originating from donor cycles or in women receiving frozen embryos originating from fresh cycles during which GnRHa was used to induce oocyte maturation suggest that it does not adversely affect the quality of the oocyte or embryo. A defective corpus luteum function resulting from the relatively short endogenous luteinizing hormone surge may be detrimental to endometrial receptivity. Aggressive luteal phase support and monitoring is therefore essential in view of the overwhelming evidence suggestive of abnormal luteal phase steroid profile. This may be achieved by the use of adequate estradiol and progesterone supplementation in the luteal phase and the first trimester. An alternative approach is the use of adjuvant low-dose human chorionic gonadotropin, although caution should be exercised in view of the associated risk of OHSS development.