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Prevent Ovarian Hyperstimulation Syndrome, OHSS,with Lupron Trigger

Posted on September 22, 2020 by Inception Fertility

Understanding Ovarian Hyperstimulation Syndrome (OHSS) and the Lupron Trigger Protocol

Ovarian Hyperstimulation Syndrome (OHSS) is a complication that can arise from in vitro fertilization (IVF). Severe OHSS occurs in about 1-2% of cases and is more common in women with polycystic ovarian syndrome (PCOS).

OHSS Symptoms

  • Enlarged ovaries and abdominal bloating
  • Fluid accumulation in the abdomen
  • Nausea, vomiting, and abdominal pain

To mitigate these risks, fertility specialists often use a "Lupron trigger protocol" to reduce or eliminate the likelihood of OHSS, especially for high-risk individuals.

Why HCG Can Trigger Hyperstimulation

The hCG trigger shot, given 35 hours before egg retrieval, can sometimes lead to hyperstimulation because it remains active in the body for up to 10 days, fueling further hormone production in the ovaries.

  • hCG effectively triggers ovulation, but for some, it overstimulates the ovaries, causing them to produce excessive hormones and potentially leading to OHSS.

How the Lupron Trigger Protocol Works

The Lupron trigger replaces hCG with a Lupron injection, effectively inducing an ovulation-triggering LH surge without prolonged hormonal stimulation.

  • Eliminates the use of hCG, thus removing the risk of OHSS.
  • Utilizes the body’s natural response for a short-lived but sufficient LH surge.

Recent Improvements in the Lupron Trigger Protocol

Earlier issues with Lupron protocols, such as lower pregnancy rates and higher miscarriage rates, were traced to inadequate luteal-phase hormonal support.

  • Enhanced protocols now include aggressive estrogen and progesterone support post-egg retrieval, achieving high pregnancy rates without OHSS risks.

Protocol Details

  • Standard GnRH antagonist ovarian stimulation protocol, replacing hCG with Lupron (1-2 mg).
  • Next-day blood tests for LH and progesterone levels to confirm response.
  • Aggressive estrogen and progesterone supplementation to support the luteal phase.

Luteal Phase Support

Hormonal support includes starting estrogen and progesterone the day after egg retrieval. Levels are monitored regularly to ensure proper uterine conditions.

  1. Estradiol patches and IM progesterone injections
  2. Weekly monitoring until 10 weeks of pregnancy
  3. Gradual weaning off support after 10 weeks

Best Candidates for the Lupron Trigger Protocol

This protocol is beneficial for women at high risk for OHSS, including those with:

Comparing HCG and Lupron Triggers

  • Lupron minimizes OHSS risk, resulting in smaller ovaries and lower luteal-phase hormone levels.
  • Provides a safer alternative for high-risk patients.

Potential Downsides of the Lupron Trigger Protocol

  • In a small percentage, Lupron does not elicit a sufficient LH surge, leading to fewer or immature eggs.
  • Some specialists supplement with a low-dose hCG to enhance response, though this can increase OHSS risk slightly.

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      Welcome to the Advanced Fertility Center of Chicago’s blog! Here, you will find information on the latest advancements in fertility care and treatments, including IVF, IUI, third-party reproduction, LGBTQ+ family building, preimplantation genetic testing, and more. Since 1997, we’ve used our experience and continuous investment in the latest fertility technology to help thousands of patients grow their families. Contact us today for more information or to schedule a new patient appointment.