title: Strategies for the management of OHSS: Results from freezing-all cycles.
abstract: OBJECTIVE
  To compare the use of GnRH agonist (GnRHa) or hCG trigger in potential OHSS patients undergoing freeze-all programs. We also compared the clinical outcomes when fresh versus freeze-thawed embryo transfers were performed in cycles with a high number of retrieved oocytes.
  
  
  METHODS
  The study included potential OHSS patients who received GnRHa (n=74) or hCG (n=49) trigger. The protocols were compared with respect to the clinical outcomes. We also compared the clinical outcomes of cycles in which hCG trigger was used and more than 20 MII oocytes were retrieved when: fresh embryo transfer protocol (n=153) or freeze-all protocol (n=123) were performed.
  
  
  RESULTS
  A decreased serum estradiol level, a decreased number of retrieved oocytes, an increased MII retrieved rate, and decreased fertilization rate was observed in the hCG when compared with the GnRHa group. No significant differences were noted concerning clinical outcomes. When fresh cycles were compared with frozen-thawed cycles, the estradiol serum level and the number of cryopreserved embryos were higher in the frozen-thawed cycles. The clinical pregnancy rate was higher among freeze-all cycles, as well as the implantation and cumulative pregnancy rates, when compared with fresh embryo transfer cycles.
  
  
  CONCLUSIONS
  The use of GnRHa trigger may be a good alternative to prevent the OHSS in patients presenting an extreme ovarian response to COS, leading to similar clinical outcomes, when compared with the traditional hCG trigger. Moreover, our findings demonstrated that the strategy of freezing-all embryos not only decreases the risk of OHSS but also leads to a better pregnancy rate.
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.|Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Assistida.
authors.forename: Edson
authors.initials: E
authors.lastname: Borges
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.|Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Assistida.|Disciplina de Urologia, Área de Reprodução Humana, Departamento de Cirurgia, Universidade Federal de São Paulo.
authors.forename: Daniela Paes Almeida Ferreira
authors.initials: DP
authors.lastname: Braga
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.|Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Assistida.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Setti
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.
authors.forename: Livia S
authors.initials: LS
authors.lastname: Vingris
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.
authors.forename: Rita Cássia S
authors.initials: RC
authors.lastname: Figueira
authors.affiliation: Fertility - Medical Group - Sao Paulo - Brazil.
authors.forename: Assumpto
authors.initials: A
authors.lastname: Iaconelli
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004624:Embryo Transfer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000706:statistics & numerical data*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; C083781:LHRH, Ala(6)-Gly(10)-ethylamide-
keywords: Freezing; GnRHa; OHSS; Thawing; Trigger; hCG