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Chapter-06 The High Responder: Optimizing the Stimulation without Complications

BOOK TITLE: Handbook of Ovarian Stimulation

Author
1. Romero Javier Martínez-Salazar
2. Sanchez Israel Ortega
3. García‑Velasco Juan Antonio
ISBN
9789352700608
DOI
10.5005/jp/books/14200_7
Edition
1/e
Publishing Year
2018
Pages
13
Author Affiliations
1. Assisted Reproduction Unit, IVI Madrid, Madrid, Spain, IVI-Madrid, Madrid, Spain
2. IVI Madrid, Madrid, Spain
3. IVI Madrid, Madrid, Spain; Nova IVI Fertility; India and GCC, Abu Dhabi, UAE; Rey Juan Carlos University, Madrid, Spain, Madrid, Spain; India and GCC, Abu Dhabi, UAE; Rey Juan Carlos University, Madrid, Spain
Chapter keywords
High ovarian response, excessive ovarian response, ovarian response, multifollicular response, high responder, controlled ovarian stimulation, gonadotropin-releasing hormone, GnRH antagonist, GnRH agonist, ovarian hyperstimulation syndrome, OHSS, gonadotropin, oocyte maturation

Abstract

Ovarian response to controlled ovarian stimulation with gonadotropins may present a broad range of biological actions in women. In this sense, clinical and biologically consensus exists to distinguish women with normal, low and high or multifollicular response. The narrow threshold of the ovarian response to ovarian stimulation in polycystic ovarian syndrome patients is known, and the boundary between the minimum effective dose of gonadotropins and the ones inducing excessive follicular development is so narrow that small dose modifications might induce high ovarian response and clinical complications, being ovarian hyperstimulation syndrome (OHSS) the most relevant one. The use of gonadotropin-releasing hormone (GnRH) antagonist protocol with low doses of recombinant follicle-stimulating hormone (100–150 IU/day) represents the gold standard in the management of patients with high ovarian response. In cases of an excessive ovarian response (> 15 mature follicles on the day of oocyte maturation), administration of GnRH agonist to trigger final oocyte maturation together with oocyte vitrification avoids the development of both the early and late OHSS.

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