Recombinant gonadotrophin-based, ovarian hyperstimulation syndrome-free stimulation of the high responder: suggested protocol for further research.

Ovarian stimulation of the high responder remains controversial. The narrow margin between a too low gonadotrophin dose (and abnormal oestradiol rise) and excessive stimulation (risk of OHSS) is a challenging situation. This study describes an OHSS-free protocol, based on the use of recombinant gonadotrophins for stimulation and gonadotrophin-releasing hormone (GnRH) antagonist to prevent premature LH surge. In six patients with a previous history of excessive response, stimulation was started on day 3 of cycle with recombinant FSH. When follicular diameter reached 13-14 mm, a daily injection of GnRH antagonist was added, together with a daily dose of 75 IU of recombinant LH. When the leading follicles reached 17 mm in diameter, ovulation was triggered with a single dose of 0.2 mg triptorelin. Luteal support with vaginal oestradiol and progesterone was started on the day of oocyte retrieval. None of the patients developed clinically significant OHSS. Mean maximal oestradiol concentration was 23,209 pmol/l, and mean number of embryos obtained per patient was 20.5. Fresh embryo transfer resulted in one ongoing pregnancy and two chemical pregnancies. Thaw cycles have resulted so far in two additional ongoing pregnancies. This protocol removes the risk of OHSS and has a good clinical outcome, and therefore merits further research.