Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious, and potentially lethal, complications of controlled ovarian stimulation (COS). Induction of final oocyte maturation with a bolus of gonadotropin-releasing hormone (GnRH) agonist (GnRHa), instead of the criterion standard hCG, in patients undergoing ovarian stimulation significantly reduces the risk of OHSS and could be considered to be more physiologic. A bolus of GnRHa used in this context also acts as a luteolytic agent. From a clinical point of view, the most significant benefit of GnRHa trigger is its ability to induce quick and reversible luteolysis and thus reducing the risk of OHSS development. This paper describes the pathophysiology of OHSS, focusing specifically on the luteolytic benefits of using GnRHa to decrease OHSS and the possible corpus luteum rescue modalities available.