Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose.

Abstract

This article reviews the biological plausibility and evidence for the use of a low triggering dose of human chorionic gonadotropin (hCG) in the prevention of ovarian hyperstimulation syndrome (OHSS). A systematic search of the literature revealed very little published data for or against the use of low-dose hCG in the prevention of OHSS after assisted reproductive technology. We have had success at avoiding OHSS as a result of gentle stimulation and low-dose sliding scale hCG trigger based on estradiol (E₂) levels. We therefore present the biological plausibility for such an approach by reviewing the relationship between OHSS, vascular endothelial growth factor, and hCG; the physiology of hCG; the relationship between risk of OHSS and E₂ at trigger; and the physiology of alternative methods of triggering such as recombinant luteinizing hormone and gonadotropin-releasing hormone agonist. We also present the results of a quasi-experimental before and after study of the sliding scale protocol for hCG trigger dose in in vitro fertilization with or without intracytoplasmic sperm injection cycles.

• Authors: Sonya Kashyap, Kasey Parker, Marcelle I Cedars, Zev Rosenwaks
• Journal: Seminars in reproductive medicine (Semin Reprod Med) Vol. 28 Issue 6 Pg. 475-85 (Nov 2010) ISSN: 1526-4564 [Electronic] United States
• PMID: 21082506 (Publication Type: Evaluation Study, Journal Article, Review)
• Copyright: © Thieme Medical Publishers.

Chemical References

• Chorionic Gonadotropin
• Fertility Agents, Female

Topics

• Chorionic Gonadotropin (administration & dosage)
• Dose-Response Relationship, Drug
• Down-Regulation
• Female
• Fertility Agents, Female (administration & dosage)
• Humans
• Oogenesis (physiology)
• Ovarian Hyperstimulation Syndrome (prevention & control)
• Ovulation Induction (methods)
• Pregnancy
• Reproductive Techniques, Assisted