In an IVF cycle using a GnRH antagonist protocol in a high responder, the clinician wishes to minimise the risk of ovarian hyperstimulation syndrome. Which agent is used to trigger final oocyte maturation?

• A Urinary hCG 10,000 IU intramuscularly
• B GnRH agonist (triptorelin) bolus ✓
• C Recombinant hCG 250 microgram subcutaneously
• D Progesterone 200 mg intramuscularly

Explanation

In antagonist cycles the pituitary remains suppressible, so a single GnRH agonist bolus produces an endogenous LH surge that matures oocytes while avoiding the prolonged luteotropic hCG effect that drives OHSS. hCG in any form is the main iatrogenic driver of OHSS and is avoided in this strategy. The trade-off is luteal phase defect, so aggressive luteal support or a freeze-all approach is required.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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