ABSTRACT
For the patient with overstimulated ovaries who is approaching the time of hCG administration, several strategies to make treatment safer may be considered. The first is to administer a low dose of hCG to initiate oocyte maturation and/or ovulation (i.e. not more than a single injection of 5000 IU) and, in patients receiving GnRH analog treatment and who therefore require luteal support, to give progesterone (400 mg per vaginum for 14 days or gestone injections im) rather than hCG. It is current practice now to use progesterone routinely for luteal support. Recombinant LH has a shorter half-life than hCG and so may reduce the risk of short-term OHSS, although it will not influence OHSS resulting from hCG produced from the trophoblast of a developing pregnancy. In protocols where GnRH antagonists are used, the preovulatory trigger can be with a single dose of a GnRH agonist, instead of hCG – again a shorter-acting preparation, which should reduce the short-term risk of OHSS.
