In IVF, ovarian hyperstimulation syndrome (OHSS) prevention in a high-risk patient (PCO morphology, AMH 7 ng/mL, >20 antral follicles) is best achieved by which strategy?

• A GnRH antagonist protocol with GnRH agonist trigger and freeze-all embryo strategy ✓
• B Long GnRH agonist protocol with low-dose FSH
• C Antagonist protocol with hCG trigger and immediate embryo transfer
• D Natural cycle IVF without any stimulation

Explanation

In women at high risk of OHSS (PCOS, high AMH, many antral follicles), the GnRH antagonist protocol with GnRH agonist trigger (instead of hCG) dramatically reduces OHSS risk by causing a physiological LH surge that is short-lived (no luteotropic persistence). Combined with a freeze-all embryo strategy (deferred frozen embryo transfer), this virtually eliminates severe OHSS. hCG trigger in a high-responder carries significant OHSS risk. Long agonist protocols predispose to OHSS.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.