I-26: The Role of Stimulating Agents and Protocols in Prevention of Severe OHSS

The goal of ovarian Stimulation for assisted reproductive technologies (ART) is obtaining multifollicular growth ovarian hyper stimulation syndrome (OHSS) is one of the most Severe and also potentially Life-threatening complications, which happens in 1-10% of IVF cycles. The most common risk factors which are related to OHSS are polycystic ovarian syndrome (PCOS), younger age, high preovulatory serum E2 Levels and GnRH- agonist down regulatory serum protocol. There are Several strategies to prevent OHSS, such as coasting, which is the most popular, GnRH antagonist protocol, clomiphen citrate and hMG and cetrorelix (GnRH Antagonist) protocol which recently, there has been a trend to use Such mild stimulation protocol to reduce OHSS and multiple pregnancy and in vitro maturation (IVM) of oocytes. The introduction of GnRH antagonist makes soft Stimulation possible and it is the time to trigger ovulation with GnRH agonist. The last approach to reduce the risk of OHSS is elective freezing of all the embryos. In IVM protocol, oocytes are collected from follicles in 8-12 mm size from unstimulated or minimally stimulated ovaries, and keep them in culture media until they get matured and then fertilized in vitro. There is no risk of OHSS and this clinical approach is patient-friendly. Clomiphen /hMG/ cetrorelix protocol also is another option for such a patients who had previons OHSS experience in GnRH agonist long protocol. This protocol can reduce the use of hMG, so it can produce more favorable outcome rather than GnRH agonist long protocol. In summary each of the approaches has advantages and disadvantages and a prospective randomized study is necessary to prove their efficacy.