1 / 31

Does GnRHa triggering completely abolish OHSS

content. Predictions: OHSS forever?No OHSS post agonist trigger!OHSS: Is it still a problem?Failures?How high can we go?Mechanism?Agonist trigger: side benefits..

roscoe
Download Presentation

Does GnRHa triggering completely abolish OHSS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Does GnRHa triggering completely abolish OHSS?

    2. content Predictions: OHSS forever? No OHSS post agonist trigger! OHSS: Is it still a problem? Failures? How high can we go? Mechanism? Agonist trigger: side benefits.

    6. Past predictions of the future

    7. ESHRE 2009: Optimizing success in ovarian stimulation protocols. A patient-centered approach Zev Rosenwaks: Improving IVF outcome with ovarian stimulation. Evidence from observational uncontrolled trials and several randomized studies: 22 publications. N=1,924 patients at risk for developing OHSS A single case reported: late-onset OHSS in a pregnant woman.

    9. OHSS: Is it still a problem? “We did not have a single case in years”

    10. Incidence of OHSS

    11. Measures to minimize OHSS: Exclusion criteria: history of OHSS, PCOS, AFC>20. In treatment: Lower hCG dose, coasting for up to 3 days, cancellation. Incidence: 100 patients (out of 1506, 6.6%) developed OHSS, moderate-severe: 51 (3.4%) patients. Incidence of OHSS: ENGAGE Study

    13. GnRHa trigger: does it always abolish OHSS?

    15. 708 PCO patients Mean E2 on trigger day=7817pg/ml 1 patient developed severe OHSS, hCG luteal support.

    22. Lower levels of inhibin A and pro-alpha C during the luteal phase after triggering oocyte maturation with GnRH agonist versus hCG Nevo et al, Fertil Steril 79:1123, 2003

    25. Summary The lower levels of luteal steroidal and nonsteroidal hormones reflect luteolysis, and may explain the mechanism of OHSS prevention by GnRH-a. Pregnancy post agonist trigger does not rescue the CL!!!

    26. Clinical use of agonist trigger opinion Primarily in the context of OHSS prevention. Prevention is total. A major reason to use GnRH antagonists in ovarian stimulation of high-risk patients: to keep the option of agonist trigger if needed.

    29. hCG does not imitate physiology! LH surge goes together with FSH surge. Is FSH surge Redundant?

More Related