Purpose

To report three cases of severe ovarian hyperstimulation syndrome (OHSS) among oncofertility patients receiving a long-acting GnRH agonist for ovarian suppression after controlled ovarian hyperstimulation (COH) with a GnRH antagonist protocol

Methods

Chart abstraction was completed for three patients at a single academic medical center. Patients included were undergoing fertility preservation prior to gonadotoxic chemotherapy. All patients underwent COH with GnRH antagonist protocol and embryo cryopreservation immediately followed by ovarian suppression with long-acting GnRH agonist. Main outcome measure was development of OHSS.

Results

Despite using GnRH agonist trigger and freezing all embryos, patients developed ascites, intermittent hyponatremia and hemoconcentration consistent with severe early-onset OHSS after receiving long-acting GnRH agonist immediately following oocyte retrieval for ovarian preservation.

Conclusions

Risk of severe OHSS may be increased when a long-acting GnRH agonist is used for ovarian suppression immediately following oocyte retrieval. A delay in initiating long-acting GnRH agonist after oocyte retrieval in patients at high risk for developing OHSS should be considered.

中文翻译：

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长效 GnRH 激动剂对不孕症患者的严重卵巢过度刺激综合征

目的

报告在使用 GnRH 拮抗剂方案进行受控卵巢过度刺激 (COH) 后接受长效 GnRH 激动剂以抑制卵巢的不孕症患者中的 3 例严重卵巢过度刺激综合征 (OHSS)

方法

在一个学术医疗中心为三名患者完成了图表抽象。包括的患者在性腺毒性化疗之前正在接受生育力保留。所有患者均接受了采用 GnRH 拮抗剂方案的 COH 和胚胎冷冻保存，随后立即采用长效 GnRH 激动剂进行卵巢抑制。主要结果测量是 OHSS 的发展。

结果

尽管使用 GnRH 激动剂触发并冷冻所有胚胎，但在取卵后立即接受长效 GnRH 激动剂以保存卵巢后，患者出现腹水、间歇性低钠血症和血液浓缩，与严重的早发性 OHSS 一致。

结论

取卵后立即使用长效 GnRH 激动剂进行卵巢抑制可能会增加严重 OHSS 的风险。对于发生 OHSS 的高风险患者，应考虑在取卵后延迟使用长效 GnRH 激动剂。