Ovarian Hyperstimulation Syndrome: Can We Eliminate It as a Complication of ART?

With the explosive increase in in vitro fertilization (IVF) cycles worldwide, the morbidity and mortality associated with ovarian hyperstimulation syndrome (OHSS) cannot be ignored. Researchers and clinicians all over the world are moving toward newer modifications to achieve the goal of OHSS-free clinic and eliminating it as a complication [1]. Segmentation of the IVF cycle with a combination of GnRH-antagonist protocol with GnRH-agonist (GnRHa) trigger followed by embryo/oocyte freezing with subsequent embryo transfer can probably eliminate the risk of OHSS after controlled ovarian stimulation (COS). In case of embryo transfer in COS cycle, combined use of a GnRH-antagonist protocol with GnRHa trigger followed by single embryo transfer (SET), preferably blastocyst, favors reduction in the incidence of OHSS. But due to luteolytic action of agonist trigger, intensive luteal phase support (LPS) should be considered with adequate monitoring for signs of OHSS. Decision making based on patient characteristics, monitoring techniques, clinical experience, laboratory outcomes, and recent evidence is the key to maintain a balance between incidence and severity of OHSS and IVF cycle outcomes in terms of successful healthy pregnancy.