A 26-year-old with PCOS undergoing IVF is at high risk for ovarian hyperstimulation syndrome (OHSS). A GnRH antagonist protocol is used. To prevent OHSS while completing the IVF cycle, which trigger and luteal support strategy is currently recommended?

• A Standard hCG trigger (10,000 IU) with progesterone-only luteal support
• B GnRH agonist trigger with freeze-all embryo strategy and luteal support for frozen-embryo transfer ✓
• C Dual trigger (GnRH agonist + low-dose hCG) with 14 days luteal progesterone
• D hCG trigger reduction to 1500 IU with intensive hCG luteal supplementation

Explanation

In antagonist protocol cycles with high OHSS risk (high antral follicle count, PCOS, AMH >3.5 ng/mL), the recommended OHSS prevention strategy is GnRH agonist trigger (instead of hCG) to induce a physiological LH/FSH surge — which is only possible in antagonist protocols — followed by a freeze-all strategy (no fresh embryo transfer, as the luteal phase is compromised after agonist trigger) with cryopreservation of all embryos for subsequent frozen-thaw transfer. This virtually eliminates moderate-to-severe OHSS. Dual trigger (agonist + low-dose hCG) is used when fresh transfer is desired but is less protective than pure agonist trigger freeze-all.

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

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Written and medically reviewed by the StethoPrep medical team.