TY - JOUR
T1 - Ovarian hyperstimulation syndrome prevention strategies
T2 - Oral contraceptive pills-dual gonadotropin-releasing hormone agonist suppression with step-down gonadotropin protocols
AU - Damario, Mark A
PY - 2010/11/29
Y1 - 2010/11/29
N2 - 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.
AB - 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.
KW - Oral contraceptives
KW - gonadotropin-releasing hormone agonist
KW - ovarian hyperstimulation syndrome
KW - polycystic ovarian syndrome
KW - step-down protocol
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U2 - 10.1055/s-0030-1265673
DO - 10.1055/s-0030-1265673
M3 - Review article
C2 - 21082505
AN - SCOPUS:78649232792
SN - 1526-8004
VL - 28
SP - 468
EP - 474
JO - Seminars in Reproductive Medicine
JF - Seminars in Reproductive Medicine
IS - 6
ER -