title: GnRH antagonist rescue of a long-protocol IVF cycle and GnRH agonist trigger to avoid ovarian hyperstimulation syndrome: three case reports.
abstract: OBJECTIVE
  To describe three clinical cases involving patients at high risk of severe ovarian hyperstimulation syndrome (OHSS) during IVF stimulation.
  
  
  METHODS
  Description of clinical management of IVF cycles and outcomes in patients at risk of developing OHSS.
  
  
  METHODS
  Reproductive medicine unit, private hospital.
  
  
  METHODS
  Three infertile patients undergoing stimulation for IVF/intracytoplasmic sperm injection presenting high risk of OHSS.
  
  
  METHODS
  IVF patients treated under long protocol presenting high risk of OHSS had their cycles rescued by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus.
  
  
  METHODS
  OHSS symptoms, pregnancy.
  
  
  RESULTS
  None of the three patients developed OHSS. One patient got pregnant after fresh embryo transfer, one patient got pregnant after frozen embryo transfer, and one patient had no oocytes retrieved despite the detection of LH in urine after the GnRH bolus.
  
  
  CONCLUSIONS
  When a patient undergoing an IVF cycle with long protocol is at high risk of severe OHSS, rescuing the cycle by withdrawing the agonist and replacing it with an antagonist and triggering ovulation with an agonist bolus could be considered without jeopardizing the safety of the patient while retaining the opportunity for success of the cycle. Further broader studies are needed.
authors.affiliation: Salud de la Mujer Dexeus, Barcelona, Spain. pacmar@dexeus.com
authors.forename: Francisca
authors.initials: F
authors.lastname: Martínez
authors.forename: Dalia Beatriz
authors.initials: DB
authors.lastname: Rodríguez
authors.forename: Rosario
authors.initials: R
authors.lastname: Buxaderas
authors.forename: Rosa
authors.initials: R
authors.lastname: Tur
authors.forename: Fulvia
authors.initials: F
authors.lastname: Mancini
authors.forename: Buenaventura
authors.initials: B
authors.lastname: Coroleu
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006801:Humans; D054315:Oocyte Retrieval; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D010060:Ovulation / Q000187:drug effects; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000008:administration & dosage; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone