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DOI: 10.1055/s-0030-1265673
Ovarian Hyperstimulation Syndrome Prevention Strategies: Oral Contraceptive Pills-Dual Gonadotropin-Releasing Hormone Agonist Suppression with Step-Down Gonadotropin Protocols
Publikationsverlauf
Publikationsdatum:
16. November 2010 (online)
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ABSTRACT
The identification of patients at high risk for excessive responses to ovarian stimulation for in vitro fertilization and embryo transfer is essential in the tailoring of safe and effective treatment strategies. Known factors associated with increased sensitivity to gonadotropins include polycystic ovary syndrome, young age, prior ovarian hyperstimulation syndrome (OHSS), high baseline antral follicle count, and high baseline ovarian volume. Although several treatment strategies have been proposed for these patients, this report describes the experience using the dual suppression with gonadotropin step-down protocol. This protocol uses oral contraceptive pretreatment in combination with a long gonadotropin-releasing hormone agonist followed by a programmed step-down in gonadotropin dosing. Hormonal characteristics of dual suppression include an improved luteinizing hormone-to-follicle-stimulating hormone ratio and lower serum androgens, particularly dehydroepiandrosterone sulfate. Clinical characteristics of the protocol include a lower cancellation rate and favorable clinical and ongoing pregnancy rates per initiated cycle while mitigating the risk of OHSS.
KEYWORDS
Oral contraceptives - gonadotropin-releasing hormone agonist - step-down protocol - polycystic ovarian syndrome - ovarian hyperstimulation syndrome
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Mark A DamarioM.D.
University of Minnesota Medical School
606 24th Avenue South, Suite 500, Minneapolis, MN 55454
eMail: damar001@umn.edu