|
Intervention | Recommendation | Effect of intervention | Level of evidence |
|
Reducing gonadotrophin dose | Recommended | “Step-up regimen” has a lower risk of OHSS, cycle cancellation from hyperstimulation, and higher rate of monofollicular ovulation in contrast to other protocols | 1b, 4 |
|
Reducing gonadotrophin duration |
Utilized as clinically appropriate | “Mild” stimulation protocol with GnRH antagonist for late suppression has a lower risk of OHSS and multiple pregnancies and is cost effective | 1b |
It also is less effective in terms of pregnancy rates than “long” protocols | 1a |
|
Individualized COS (iCOS) | Further research required | iCOS can reduce OHSS rates and associated cycle cancellations. It also produces a significant oocyte yield and good pregnancy rates | 1b, 2a |
|
GnRHa as an ovulation trigger | Recommended | GnRHa use virtually eliminates OHSS rates | 1b |
|
hCG as an ovulation trigger | Further research required | Lowest dose of hCG does not seem to reduce OHSS rates | 2a, 2b, 4 |
|
Adjuvant metformin therapy | Recommended | Metformin is associated with a lower risk of OHSS and increased clinical pregnancy rate | 1a, 4 |
|
Cabergoline | Recommended | Cabergoline reduces the incidence of OHSS without an effect on pregnancy rates | 1a |
|
Hydroxyethyl starch | Utilized as clinically appropriate | HES causes a decrease in OHSS without an effect on pregnancy rates | 1a |
|
Coasting | Further research required | Coasting does not completely prevent OHSS, is associated with a lower oocyte yield, and has no benefit in contrast to other interventions. The protocols are also very diverse | 1a, 4 |
|
Cryopreservation |
Utilized as clinically appropriate | Cryopreservation alone does not reduce rates of OHSS | 1a |
GnRHa followed by cryopreservation virtually eliminates OHSS | 1b |
|
Cycle cancellation | Utilized as clinically appropriate | Cancellation completely eliminates risk of OHSS but has a high financial and emotional burden | 4 |
|
Adjunct GnRHa use | Not recommended | GnRHa use increases the associated costs and rate of OHSS while lowering the pregnancy rates | 1a |
|
Aromatase inhibitors for OI | Not recommended | AIs have shown no reduction in rates of OHSS in contrast to other methods of OI | 1a |
|
rhLH | Not recommended | rhLH use does not reduce the risk of OHSS and has higher costs and lower pregnancy rates | 1a, 1b |
|
hCG for luteal phase support | Not recommended | Progesterone significantly reduces the risk of OHSS with improved clinical pregnancy rates and live birth rates in comparison to hCG for LPS | 1a |
|
Albumin infusion | Not recommended | Albumin does not reduce OHSS rates and may cause lower pregnancy rates. There are also associated risks with anaphylaxis and disease transmission | 1a |
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Vasopressin V1a receptor antagonist | Further research required | It appears to reduce the ovarian weight gain and multiple corpus luteum development in OHSS | 2b |
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