In women with PCOS undergoing IVF who are at high risk of ovarian hyperstimulation syndrome (OHSS), which antagonist-protocol trigger modification is MOST effective in preventing severe OHSS while maintaining reasonable oocyte yield?

• A GnRH agonist trigger instead of hCG, followed by freeze-all strategy ✓
• B Continuing the GnRH antagonist for an additional 5 days before oocyte retrieval
• C Reducing FSH dose by 50% in the final 3 days of stimulation
• D Adding cabergoline 0.5 mg daily from the day of trigger for 8 days

Explanation

In a GnRH antagonist protocol, substituting the hCG trigger with a GnRH agonist trigger (e.g., triptorelin 0.2 mg SC) induces an endogenous LH surge of shorter duration (36 hours vs. 14 days for hCG), dramatically reducing the risk of OHSS. Combining this with a freeze-all strategy (no fresh transfer) eliminates the risk of late OHSS from pregnancy-driven hCG rise. This is now the standard approach in high-risk patients. Cabergoline (dopamine agonist) partially reduces OHSS via VEGF-R2 but is less effective than agonist trigger.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.