The assisted reproduction procedures are perfectly safe medical interventions, but unfortunately there are many myths regarding the impact of IVF on the health of the patients who undergo it. However, if one were to ask what a real complication of IVFcould be, nobody would hesitate to mention the ovarian hyperstimulation syndrome.
The ovarian hyperstimulation is a potentially life-threatening condition and is generally caused by vasoactive factors secreted by the excessive follicle production during a stimulation cycle. In cases of ovarian hyperstimulation, the excessive intravascular volume of plasma is displaced into other parts of the body such as various body cavities, causing ascites, pleuropathic or even pericardial plasma collection.
But nowadays, can we help couples to have a family without exposing them to the slightest risk of ovarian hyperstimulation and in other words can we build an OHSS FREE IVF CLINIC?
Of course we can! The suggestions of the scientific literature most emphatically conclude that if the proper steps are followed, the risk of ovarian hyperstimulation is reduced to well below 0.5%.
But what are these steps ?
A safe and successful IVF attempt is based on a careful analysis of our patient’s history and our personalised approach to the problem that causes infertility.
- Adjusting the gonadotropin dosage
A gonadotropin dosage that is proportional to the age and hormonal profile of the patient we are managing should be chosen, taking of course into account the previous reproductive history, such as a history of hyperstimulation in the past. For example, in a young, thin woman with a history of polycystic ovaries, only “mild” stimulation would be suggested. In other words, a low dose of gonadotropins will be chosen, with careful monitoring of her ovarian response to prevent overstimulation, and any other protocol that uncontrollably stimulates the follicular production will be rejected.
Therefore, in cases where an asymmetric ovarian response is likely to happen, the starting dose of gonadotropins should be low and the first ultrasound scan of the ovarian response should be carried out as early as possible.
- Selection of the appropriate protocol
In addition to dosage, the choice of the appropriate protocol is crucial. So while all stimulation protocols are considered more or less comparable to each other in terms of efficacy rates, one stands out in terms of the overstimulation risk.
This particular protocol is the short antagonist protocol because it is the only one that uses a different way of inducing the final phase of ovulation (triggering), compared to the conventional protocol that involves use of chorionic gonadotropin that is associated with a statistically significant risk of inducing hyperstimulation. Therefore, in cases that, despite the above-mentioned precautions, the ovarian system overreacts, this protocol makes it possible to induce the final maturation of the follicles in a way which practically eliminates the possibility of clinical occurrence of the ovarian hyperstimulation syndrome, by using the GNRH agonists.The GNRH agonist formulation, unlike the chorionic gonadotropin which is usually administered for the final triggering, is metabolised much faster and does not trigger further follicular development, and therefore it eliminates the overstimulation procedure.
- Cryopreservation of created embryos
Finally, if there is still a fear of possible ovarian overstimulation in the event of pregnancy, after the ovulation and the egg retrieval, the embryo transfer can be postponed and all the created embryos can be frozen. Like in the most modern way of IVF, the embryo transfer of frozen embryos can be performed in a future cycle after the preparation of the endometrial cavity to allow implantation to happen.
All the above interventions ensure the safety of our patient against the unique risk involved in the application of assisted reproduction techniques.
