title: Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin trigger dose.
abstract: This article reviews the biological plausibility and evidence for the use of a low triggering dose of human chorionic gonadotropin (hCG) in the prevention of ovarian hyperstimulation syndrome (OHSS). A systematic search of the literature revealed very little published data for or against the use of low-dose hCG in the prevention of OHSS after assisted reproductive technology. We have had success at avoiding OHSS as a result of gentle stimulation and low-dose sliding scale hCG trigger based on estradiol (E₂) levels. We therefore present the biological plausibility for such an approach by reviewing the relationship between OHSS, vascular endothelial growth factor, and hCG; the physiology of hCG; the relationship between risk of OHSS and E₂ at trigger; and the physiology of alternative methods of triggering such as recombinant luteinizing hormone and gonadotropin-releasing hormone agonist. We also present the results of a quasi-experimental before and after study of the sliding scale protocol for hCG trigger dose in in vitro fertilization with or without intracytoplasmic sperm injection cycles.
authors.affiliation: UCSF Women's Health Clinical Research Center & UCSF Center for Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, California, USA. skashyap@genesis-fertility.com
authors.forename: Sonya
authors.initials: S
authors.lastname: Kashyap
authors.forename: Kasey
authors.initials: K
authors.lastname: Parker
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Zev
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D015536:Down-Regulation; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D006801:Humans; D009866:Oogenesis / Q000502:physiology; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female