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Does GnRHa triggering completely abolish OHSS

content. Predictions: OHSS forever?No OHSS post agonist trigger!OHSS: Is it still a problem?Failures?How high can we go?Mechanism?Agonist trigger: side benefits..

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Does GnRHa triggering completely abolish OHSS

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    1. Does GnRHa triggering completely abolish OHSS?

    2. content Predictions: OHSS forever? No OHSS post agonist trigger! OHSS: Is it still a problem? Failures? How high can we go? Mechanism? Agonist trigger: side benefits.

    6. Past predictions of the future

    7. ESHRE 2009: Optimizing success in ovarian stimulation protocols. A patient-centered approach Zev Rosenwaks: Improving IVF outcome with ovarian stimulation. Evidence from observational uncontrolled trials and several randomized studies: 22 publications. N=1,924 patients at risk for developing OHSS A single case reported: late-onset OHSS in a pregnant woman.

    9. OHSS: Is it still a problem? �We did not have a single case in years�

    10. Incidence of OHSS

    11. Measures to minimize OHSS: Exclusion criteria: history of OHSS, PCOS, AFC>20. In treatment: Lower hCG dose, coasting for up to 3 days, cancellation. Incidence: 100 patients (out of 1506, 6.6%) developed OHSS, moderate-severe: 51 (3.4%) patients. Incidence of OHSS: ENGAGE Study

    13. GnRHa trigger: does it always abolish OHSS?

    15. 708 PCO patients Mean E2 on trigger day=7817pg/ml 1 patient developed severe OHSS, hCG luteal support.

    22. Lower levels of inhibin A and pro-alpha C during the luteal phase after triggering oocyte maturation with GnRH agonist versus hCG Nevo et al, Fertil Steril 79:1123, 2003

    25. Summary The lower levels of luteal steroidal and nonsteroidal hormones reflect luteolysis, and may explain the mechanism of OHSS prevention by GnRH-a. Pregnancy post agonist trigger does not rescue the CL!!!

    26. Clinical use of agonist trigger opinion Primarily in the context of OHSS prevention. Prevention is total. A major reason to use GnRH antagonists in ovarian stimulation of high-risk patients: to keep the option of agonist trigger if needed.

    29. hCG does not imitate physiology! LH surge goes together with FSH surge. Is FSH surge Redundant?

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