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Semin Reprod Med 2010; 28(6): 475-485
DOI: 10.1055/s-0030-1265674
© Thieme Medical Publishers

Ovarian Hyperstimulation Syndrome Prevention Strategies: Reducing the Human Chorionic Gonadotropin Trigger Dose

Sonya Kashyap1 , Kasey Parker2 , Marcelle I. Cedars1 , Zev Rosenwaks3
  • 1UCSF Women's Health Clinical Research Center & UCSF Center for Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, California
  • 2Ottawa Health Research Institute, Ottawa, Canada
  • 3The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weil Cornell Medical College, New York, New York
Further Information

Publication History

Publication Date:
16 November 2010 (online)

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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.

KEYWORDS

Ovarian hyperstimulation syndrome - prevention - low-dose hCG

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Sonya KashyapM.D. F.R.C.S.C. M.Sc. Epi, d'A.BO.G. 

Co-Director, Genesis Fertility Centre, Suite 300

1367 West Broadway Avenue, Vancouver, BC, V6H 4A7 Canada

Email: skashyap@genesis-fertility.com

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