Embryo freezing to prevent ovarian hyperstimulation syndrome

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology (ART)

Background:

• Assisted reproductive technology (ART) aims for supraphysiologic ovarian stimulation, which carries the risk of ovarian hyperstimulation syndrome (OHSS).
• Severe OHSS is life-threatening, and while its incidence is low, the increasing use of ART globally suggests a rise in absolute cases.
• OHSS is more severe in patients who conceive, highlighting the need for risk mitigation strategies.

Purpose of the Study:

• To discuss strategies for preventing and managing ovarian hyperstimulation syndrome (OHSS) in the context of assisted reproductive technology (ART).
• To evaluate methods for mitigating the risk of severe OHSS while preserving oocyte retrieval and optimizing pregnancy outcomes.

Main Methods:

• Reviewing established protocols for managing excessive ovarian response during ART cycles.
• Analyzing the efficacy of cycle cancellation, hCG withholding, and elective cryopreservation of embryos.
• Examining the impact of bypassing fresh embryo transfer in favor of frozen embryo transfers on OHSS risk and pregnancy rates.

Main Results:

• Cycle cancellation and withholding hCG are effective in preventing OHSS when excessive ovarian response occurs.
• Elective cryopreservation of all embryos, without fresh transfer, reduces but does not eliminate the risk of severe OHSS.
• Pregnancy success rates are high with subsequent cryopreserved-thawed embryo transfers.

Conclusions:

• Accurate identification of patients at risk for OHSS is crucial for implementing preventive strategies.
• Bypassing fresh embryo transfer and opting for frozen embryo transfers is a viable approach to lessen OHSS risk.
• Cryopreservation strategies combined with frozen embryo transfers maintain excellent pregnancy potential in ART.