Prediction and prevention of ovarian hyperstimulation syndrome (OHSS)

As success rates of Assisted Reproductive Techniques (ART) have improved and the use of egg donation as a treatment modality has increased, more and younger patients are being treated with injectable menotropins. There is an 80% chance of severe OHSS developing when there are > 29 follicles and the estradiol level is > 6000 pg/ml. In the past, the only way of avoiding severe OHSS, was to withhold the administration of human chorionic gonadotropin (HCG) and cancel the cycle or run the risk of OHSS by proceeding with retrieval. We present data from 697 consecutive egg retrieval procedures during which we applied the procedure called ''prolonged coasting'' to all the patients at risk of hyperstimulation. There were no canceled cycles in this high risk group, and no patients developed severe hyperstimulation syndrome. The clinical pregnancy results were 56% in women under 40, 69% in women using an egg donor and 67% in women over 40, Strict adherence to the protocol of ''prolonged coasting'' prevents unnecessary cancellation of cycles and eliminates the risk of severe hyperstimulation syndrome with excellent pregnancy outcome.