WITHHOLDING GONADOTROPIN ADMINISTRATION IS AN EFFECTIVE ALTERNATIVE FOR THE PREVENTION OF OVARIAN HYPERSTIMULATION SYNDROME

Objective: To evaluate the outcomes of NF and the incidence of ovarian hyperstimulation syndrome (OHSS) after discontinuing gonadotropin the rapy in patients at risk of developing OHSS by delaying hCG administra tion until a drop in serum E(2) levels was observed. Design: Retrospec tive study. Setting: IVF program at a university center. Interventions : Gonadotropin administration was withheld in 22 patients (group 1) wh en their serum E(2) level was greater than or equal to 3,000 pg/mL (co nversion factor to SI unit, 3.671). Patients continued GnRH analogue i njections daily, and hCG was administered when serum E(2) levels dropp ed to less than or equal to 3,000 pg/mL. Outcomes were compared with 2 6 patients (group 2) in whom embryo transfer was canceled and all embr yos cryopreserved for transfer during a subsequent unstimulated cycle. Main Outcome Measures: Outcomes of IVF and incidence of OHSS were com pared in both groups of patients. In group 1, follicular and hormonal parameters before and after the coasting interval were compared in pre gnant versus nonpregnant patients. In addition, serum hormonal profile s were evaluated daily during the coasting period to determine the eff ects of gonadotropin withdrawal. Results: Although the mean number of oocytes retrieved was significantly higher in group 2, fertilization r ates, miscarriage rates, delivery rates/stimulation cycle, and the inc idence of OHSS did not differ significantly between the two groups. Co nclusion: Withholding gonadotropin administration is an effective alte rnative to prevent the development of severe OHSS in a high-risk popul ation. Although the risk of cancellation cannot be completely eliminat ed, this strategy can provide a high pregnancy rate without the need t o repeat multiple frozen-thawed cycles. (C) 1997 by American Society f or Reproductive Medicine.