OHSS-Prevention

 

OHSS:---Prevalence:-upto 10% especially if agonists are used along with  Gonadotrophins in high dose as is usually done(long protocol) . But prevalence will be less in other methods of Ov Induction  protocol.

A)      Who are more prone &  in which cases doctor should be more cautious?

 1) Lean PCOS,2)  Hyperandrogenic women 3) Young age ,4)  Low  BMI 5)   6) P/H/O OHSS 7) Rapidly rising E2 & if on the day of trigger E2 is > 6000 pg/ml.( Normal ON DAY OF Trigger of plasma E2 will be  about 500-1500 pg/ml) .8) USG prior to oV Induction and selection of protocol.—if exhibit  PCOM/-Pcos type of USGà but no systemic symptoms or sign of PCOS . Therefore women who exhibit polyfollicular features  which are insignificant metabolically or have no menst disorders per se in non-preg state. Such women with polyfollicular pattern these PCOM women while on stimulation will hyperresponders in 40% cases.

 

 

B)        Doctor is an experienced and wel aware of the fact thwt Ms XYZ can deveop OHSS . Then , how she / he will prevent OHSS if there is any risk factor/ factors are already present?

1)                   Daily USG including search for ascites 2) Hematocrit 3) To opt for  Chr low dose protocol in next cycle-more so who are more prone for OHSS e.g. Lean PCOS, 2) Hyperandrogenic women 3) Young age, 4) Low BMI   4) Coasting: - Stop administering further gonadotrophins-watch but if one gives trigger that must be administered by 72 hrs after stoppage of HMG (i.e. initiation of coasting)  5) Can Cancel the cycle. 6) IVM –In vitro maturation after aspirating immature oocytes 7) Cryopreservation-all Freeze->Transfer  in later cycles. 8) Plasma Expanders. 9) Trigger by agonist-e.g. Decapaptyl-0.5 mg to 0.1 mg; but not r-LH neither  HCG:

But the problem is that this agonist trigger will not work if the cycle was down regulated by Long protocol (Long agonist suppression) or Antagonist protocol 10) Aspirate all follicles 11) If down regulated with agonist –one can continue the agonist even after HCG triggerà this policy will lessen the release of vasoactive substances.

2)                   When to withhold trigger? If there are > 2 DF above 18 mm in IUI cycles .