New algorithm for OHSS prevention
New algorithm for OHSS prevention
Blog Article
Abstract Ovarian hyperstimulation syndrome (OHSS) still remains a life-threatening complication of in vitro fertilization treatment (IVF), keeping patients and especially those, who previously experienced OHSS, from attempting infertility treatment and childbearing.The recent implementation of four new modalities: the GnRH antagonist protocol, GnRH agonist (GnRHa) triggering of ovulation, blastocyst transfer and embryo/oocyte vitrification, renders feasible the elimination of OHSS in connection with ovarian hyperstimulation for IVF treatment.The proposed current algorithm Food Service:Commercial Kitchen Equipment:Cooking Equipment:Commercial Sandwich is based on the number of follicles developed after ovarian stimulation, setting a cut-off level at the development of 18 or more follicles.Further, fulfilling this criterion, the algorithm is based on four decision-making points: the final day of patient work-up, the day of triggering final oocyte maturation, day-1 post oocyte pick-up (OPU) and day-5 post OPU.If the physician decides to administer hCG for final oocyte maturation regardless the type of analogue used, he has the option on day-1 to either freeze all embryos or to proceed to day-5.
On this day, based on the clinical condition of the patient, a decision should be made to either transfer a single blastocyst or to vitrify all blastocysts available.However, this strategy will not guarantee an OHSS free luteal phase especially if a pregnancy occurs.If the physician decides to trigger ovulation with GnRHa, feasible only with the antagonist protocol, embryos can be cultured until day-5.On this day a transfer can be performed with no risk of OHSS and spare blastocysts may be vitrified.Alternatively, on day-1 or day-2 post OPU, all embryos could be frozen.
Hopefully, in Conditioner for Color-treated Hair a near future, GnRHa triggering and vitrification of oocytes will become everyday practice.Only the combined use of a GnRH antagonist protocol with GnRHa triggering and subsequent single blastocyst transfer or embryo/oocyte freezing will completely abolish the risk of OHSS after ovarian hyperstimulation.