Minimising OHSS in women with PCOS

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilisation (IVF)
• Women's Health

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation during IVF.
• Women with polycystic ovary syndrome (PCOS) face a substantially increased risk of developing OHSS.

Purpose of the Study:

• To review current evidence for strategies to mitigate OHSS risk in women with PCOS undergoing IVF.
• To identify methods for optimizing IVF safety in this high-risk population.

Main Methods:

• Review of current evidence on OHSS risk mitigation strategies.
• Identification of high-risk patients and pre-treatment counseling.
• Analysis of specific interventions including metformin co-treatment, GnRH antagonist/PPOS protocols, appropriate gonadotropin dosing, GnRH agonist trigger, embryo cryopreservation, and dopamine-agonist treatment.

Main Results:

• Several strategies can significantly reduce OHSS risk in PCOS patients.
• These include specific medication protocols (metformin, GnRH antagonist/PPOS), adjusted gonadotropin dosing, GnRH agonist trigger, and deferred frozen embryo transfer.
• In vitro maturation (IVM) is an alternative with no OHSS risk but currently lower live birth rates.

Conclusions:

• Implementing identified strategies can prevent significant early and late OHSS in women with PCOS.
• Optimizing IVF safety for high-risk PCOS patients is crucial.
• The goal is to achieve OHSS-free IVF treatment for all patients.