ArticleLow-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles
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Geeta Nargund is Head of Reproductive Medicine at St George's Hospital and Medical Director of the Centre of Reproduction and Advanced Technology, London, UK. She is also Chief Executive of the Health Education Research Trust (HER Trust) UK and the President of ISMAAR (International Society for Mild Approaches in Assisted Reproduction). She has published extensively on the role of advanced ultrasound technology in reproductive medicine. She is the chief author of the first scientific paper on
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The case for mild stimulation for IVF: recommendations from The International Society for Mild Approaches in Assisted Reproduction
2022, Reproductive BioMedicine OnlineCitation Excerpt :If agonist trigger is used, FAE seems to be essential: not only because the pregnancy rate has been shown to be compromised with fresh embryo transfer (Roque et al., 2019; Youssef et al., 2014), but also the risk of OHSS is not reduced when a small dose of HCG (such as a 1500 IU single dose) is added to reinforce luteal phase support (Youssef et al., 2014). A gonadotrophin dose of ≤150 IU/day and lower than standard dose of HCG (Nargund et al., 2007) could be a safer way when a fresh embryo transfer is contemplated. In-vitro maturation (IVM) can be a useful alternative in high-responder groups.
Triggering with 1,500 IU of human chorionic gonadotropin plus follicle-stimulating hormone compared to a standard human chorionic gonadotropin trigger dose for oocyte competence in in vitro fertilization cycles: a randomized, double-blinded, controlled noninferiority trial
2022, Fertility and SterilityCitation Excerpt :Our findings showed that this alternative trigger was effective at yielding noninferior oocyte competence compared to a standard hCG dose, with no incidence of OHSS. Although 5,000 or 10,000 IU of urinary hCG has been maintained as the standard trigger doses traditionally used in IVF, a few prior studies have demonstrated that much lower doses of hCG (i.e., 1,000–2,500 IU) are capable of inducing oocyte competence (7–12, 14, 15). For example, a pilot study triggered 21 women at high risk for severe OHSS with 2,500 IU hCG and all patients had mature fertilizable oocytes retrieved with a pregnancy rate of 61.9% after fresh ET while none had OHSS (7).
Electroacupuncture decreases the progression of ovarian hyperstimulation syndrome in a rat model
2016, Reproductive BioMedicine OnlineCitation Excerpt :It has been reported that the fundamental physiological change related to OHSS is characterized by increased vascular permeability, leading to the leakage of fluid from the vascular compartment, with third-space fluid accumulation and intravascular dehydration (Chen et al., 2012). VEGF, also known as vascular permeability factor, seems to be the critical mediator of OHSS by increasing vascular permeability (Ludwig et al., 1998; Mansour et al., 2005; Nargund et al., 2007; Rizk et al., 1997). Gomez et al. (2002) reported a cause–effect relationship between increased vascular permeability and ovarian VEGF expression (Gomez et al., 2002).
The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF-ICSI
2015, Reproductive BioMedicine OnlineSuccessful pregnancy and birth in A FET cycle following the triggering of oocyte maturation with 800 IU of human chorionic gonadotropin
2014, Journal of Reproduction and ContraceptionA potential novel strategy, inhibition of vasopressin-induced VEGF secretion by relcovaptan, for decreasing the incidence of ovarian hyperstimulation syndrome in the hyperstimulated rat model
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Therefore, fundamental physiologic change related to OHSS is characterized by increased vascular permeability (VP), leading to leakage of fluid from the vascular compartment, with third-space fluid accumulation and intravascular dehydration [3]. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor, seems to be the principal mediator of OHSS by increasing VP [4–7]. One of the main strategies to prevent OHSS is to utilize preventive therapy modalities during stimulation.
Geeta Nargund is Head of Reproductive Medicine at St George's Hospital and Medical Director of the Centre of Reproduction and Advanced Technology, London, UK. She is also Chief Executive of the Health Education Research Trust (HER Trust) UK and the President of ISMAAR (International Society for Mild Approaches in Assisted Reproduction). She has published extensively on the role of advanced ultrasound technology in reproductive medicine. She is the chief author of the first scientific paper on cumulative live birth rates of natural (unstimulated) cycle IVF and on one-stop fertility diagnosis using ultrasound technology. Her research interests include minimal approaches in assisted reproduction and advanced ultrasound technology.
Paper based on a contribution presented at the First World Congress on ‘Natural Cycle/Minimal Stimulation IVF’ in London, UK, December 15–16, 2006.