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Journal of Assisted Reproduction and Genetics

Erschienen in:

15.09.2023 | Assisted Reproduction Technologies

The HERA (Hyper-response Risk Assessment) Delphi consensus for the management of hyper-responders in in vitro fertilization

verfasst von: I. Feferkorn, S. Santos-Ribeiro, F. M. Ubaldi, J. G. Velasco, B. Ata, C. Blockeel, A. Conforti, S. C. Esteves, H. M. Fatemi, L. Gianaroli, M. Grynberg, P. Humaidan, G.T Lainas, A. La Marca, L. B. Craig, R. Lathi, R. J. Norman, R. Orvieto, R. Paulson, A. Pellicer, N. P. Polyzos, M. Roque, S. K. Sunkara, S. L. Tan, B. Urman, C. Venetis, A. Weissman, H. Yarali, M. H. Dahan

Erschienen in: Journal of Assisted Reproduction and Genetics | Ausgabe 11/2023

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Abstract

Purpose

To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS)

Methods

A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori, it was decided that consensus would be reached when ≥66% of the participants agreed, and ≤3 rounds would be used to obtain this consensus. A total of 28/31 experts responded (selected for global coverage), anonymous to each other.

Results

A total of 26/28 statements reached consensus. The most relevant are summarized here. The target number of oocytes to be collected in a stimulation cycle for IVF in an anticipated hyper-responder is 15–19 (89.3% consensus). For a potential hyper-responder, it is preferable to achieve a hyper-response and freeze all than aim for a fresh transfer (71.4% consensus). GnRH agonists should be avoided for pituitary suppression in anticipated hyper-responders performing IVF (96.4% consensus). The preferred starting dose in the first IVF stimulation cycle of an anticipated hyper-responder of average weight is 150 IU/day (82.1% consensus). ICoasting in order to decrease the risk of OHSS should not be used (89.7% consensus). Metformin should be added before/during ovarian stimulation to anticipated hyper-responders only if the patient has PCOS and is insulin resistant (82.1% consensus). In the case of a hyper-response, a dopaminergic agent should be used only if hCG will be used as a trigger (including dual/double trigger) with or without a fresh transfer (67.9% consensus). After using a GnRH agonist trigger due to a perceived risk of OHSS, luteal phase rescue with hCG and an attempt of a fresh transfer is discouraged regardless of the number of oocytes collected (72.4% consensus). The choice of the FET protocol is not influenced by the fact that the patient is a hyper-responder (82.8% consensus). In the cases of freeze all due to OHSS risk, a FET cycle can be performed in the immediate first menstrual cycle (92.9% consensus).

Conclusion

These guidelines for the management of hyper-response can be useful for tailoring patient care and for harmonizing future research.

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Titel: The HERA (Hyper-response Risk Assessment) Delphi consensus for the management of hyper-responders in in vitro fertilization
verfasst von: I. Feferkorn
S. Santos-Ribeiro
F. M. Ubaldi
J. G. Velasco
B. Ata
C. Blockeel
A. Conforti
S. C. Esteves
H. M. Fatemi
L. Gianaroli
M. Grynberg
P. Humaidan
G.T Lainas
A. La Marca
L. B. Craig
R. Lathi
R. J. Norman
R. Orvieto
R. Paulson
A. Pellicer
N. P. Polyzos
M. Roque
S. K. Sunkara
S. L. Tan
B. Urman
C. Venetis
A. Weissman
H. Yarali
M. H. Dahan
Publikationsdatum: 15.09.2023
Verlag: Springer US
Erschienen in: Journal of Assisted Reproduction and Genetics / Ausgabe 11/2023
Print ISSN: 1058-0468
Elektronische ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-023-02918-5

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