GnRH antagonist rescue of a long-protocol IVF cycle and GnRH agonist trigger to avoid ovarian hyperstimulation syndrome: three case reports.

To describe three clinical cases involving patients at high risk of severe ovarian hyperstimulation syndrome (OHSS) during IVF stimulation. Description of clinical management of IVF cycles and outcomes in patients at risk of developing OHSS. Reproductive medicine unit, private hospital. Three infertile patients undergoing stimulation for IVF/intracytoplasmic sperm injection presenting high risk of OHSS. IVF patients treated under long protocol presenting high risk of OHSS had their cycles rescued by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus. OHSS symptoms, pregnancy. None of the three patients developed OHSS. One patient got pregnant after fresh embryo transfer, one patient got pregnant after frozen embryo transfer, and one patient had no oocytes retrieved despite the detection of LH in urine after the GnRH bolus. When a patient undergoing an IVF cycle with long protocol is at high risk of severe OHSS, rescuing the cycle by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus could be considered without jeopardizing the safety of the patient while retaining the opportunity for success of the cycle. Further broader studies are needed.

Martínez F ，Rodríguez DB ，Buxaderas R ，Tur R ，Mancini F ，Coroleu B ... -  《-》

Intranasal gonadotropin-releasing hormone agonist (GnRHa) for luteal-phase support following GnRHa triggering, a novel approach to avoid ovarian hyperstimulation syndrome in high responders.

To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa. Retrospective cohort study. Private fertility clinic. Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyperstimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated. Intranasal GnRHa for luteal-phase support. The primary outcome was ongoing clinical pregnancy rate. High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS. Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients triggered with GnRHa and avoiding OHSS.

Bar-Hava I ，Mizrachi Y ，Karfunkel-Doron D ，Omer Y ，Sheena L ，Carmon N ，Ben-David G ... -  《-》

Gonadotropin-releasing hormone agonist combined with a reduced dose of human chorionic gonadotropin for final oocyte maturation in fresh autologous cycles of in vitro fertilization.

Shapiro BS ，Daneshmand ST ，Garner FC ，Aguirre M ，Thomas S ... -  《-》

Can FSH co-trigger prevent OHSS?

FSH co-trigger after ovarian stimulation has been shown to improve oocyte competence and a recent report suggested that the FSH co-trigger can completely prevent OHSS. We report two cases of late OHSS after the FSH co-trigger was administered, underscoring the need for further research on the mechanisms, effects, benefits, and potential risks of FSH co-trigger.

Rosen MP ，Meldrum DR 《-》

Short coasting of 1 or 2 days by withholding both gonadotropins and gonadotropin-releasing hormone agonist prevents ovarian hyperstimulation syndrome without compromising the outcome.

Moon HS ，Joo BS ，Moon SE ，Lee SK ，Kim KS ，Koo JS ... -  《-》