Objective : To review the up-to-date randomized controlled trials (RCT) & meta-analyses concerning prevention of
ovarian hyperstimulation syndrome (OHSS).
Designs: An electronic search of the Cochrane library, Pub Mcd for RCT & meta-analyses concerning OHSS from
1990 to 2005.
Results : Six Cochrane systematic reviews, 4 rncta-analyscs & 28 ReT were reviewed as regarding choice of the
treatment regimen, preventive measures on the day of human chorionic gonadotrpin (HCG), on the day of oocyte
retrieval, at the time of embryo transfer & during the luteal phase.
Conclusions: l. Laparoscopic ovarian drilling & usc or urinary follicle stimulating homone (uFSH) rather than human
menopausal gonadotropin (HMG) in stimulation cycles without concomitant use of a GnRh-a are associated with
reduction of OHSS in polycystic ovary syndrome (PCOS). 2. Significant reduction in incidence of OHSS is observed
with low dose step up FSH protocol. 3. Recombinant luteinising homonc (rLH) results in a highly significant reduction
in OHSS compared to urinary luteinising hormone (uHCG). 4. Use of gonadotropin releasing hormone agonist
(GnRHa) instead of HCG in antagonist protocol is associated with reduction of OHSS. 5. There is insufficient evidence
to determine if coasting is an effective strategy for preventing OHSS 6. Administration of human albumin is not
effective in reduction of severe OHSS. 7. Given the increased risk of OHSS associated with HeG, intramuscular (1M)
progesterone is favored for luteal phase supplementation.