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Semin Reprod Med 2010; 28(6): 468-474
DOI: 10.1055/s-0030-1265673
© Thieme Medical Publishers

Ovarian Hyperstimulation Syndrome Prevention Strategies: Oral Contraceptive Pills-Dual Gonadotropin-Releasing Hormone Agonist Suppression with Step-Down Gonadotropin Protocols

Mark A. Damario1
  • 1Medical Director, Reproductive Medicine Center; Division Director, Division of Reproductive Endocrinology and Infertility; Associate Professor, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, Minnesota
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Publication History

Publication Date:
16 November 2010 (online)

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ABSTRACT

The identification of patients at high risk for excessive responses to ovarian stimulation for in vitro fertilization and embryo transfer is essential in the tailoring of safe and effective treatment strategies. Known factors associated with increased sensitivity to gonadotropins include polycystic ovary syndrome, young age, prior ovarian hyperstimulation syndrome (OHSS), high baseline antral follicle count, and high baseline ovarian volume. Although several treatment strategies have been proposed for these patients, this report describes the experience using the dual suppression with gonadotropin step-down protocol. This protocol uses oral contraceptive pretreatment in combination with a long gonadotropin-releasing hormone agonist followed by a programmed step-down in gonadotropin dosing. Hormonal characteristics of dual suppression include an improved luteinizing hormone-to-follicle-stimulating hormone ratio and lower serum androgens, particularly dehydroepiandrosterone sulfate. Clinical characteristics of the protocol include a lower cancellation rate and favorable clinical and ongoing pregnancy rates per initiated cycle while mitigating the risk of OHSS.

KEYWORDS

Oral contraceptives - gonadotropin-releasing hormone agonist - step-down protocol - polycystic ovarian syndrome - ovarian hyperstimulation syndrome

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Mark A DamarioM.D. 

University of Minnesota Medical School

606 24th Avenue South, Suite 500, Minneapolis, MN 55454

Email: damar001@umn.edu

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