GnRH antagonist rescue of a short-protocol IVF/ICSI cycle and GnRH agonist triggering to prevent ovarian hyperstimulation syndrome: two case reports

Abstract

To describe two clinical cases concerning patients at risk of developing severe ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) stimulation. Description of clinical management and outcomes of patients using an IVF antagonist rescue protocol to prevent OHSS. Reproductive medicine unit, University Hospital. Two infertile patients undergoing controlled ovarian stimulation (COS) for IVF/intracytoplasmic sperm injection (ICSI) presenting with high risk of OHSS. IVF/ICSI patients following COS under short protocol and high risk of OHSS were managed by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus. Main outcome measures included incidence of OHSS, oocytes retrieved, and pregnancy rates. None of the two patients developed OHSS. None of the patients had metaphase II retrieved oocytes at oocyte retrieval. Use of COS with short protocol in an IVF/ICSI cycle carries a risk of severe OHSS. Rescuing the cycle by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus is not always effective and should not be used if short time interval between agonist replacement with antagonist and ovulation triggering is available.