Can we eliminate severe ovarian hyperstimulation syndrome?

The desire of some couples for children is so strong that they are willing to accept a modicum of risk to treat their infertility. Ideally, assisted reproduction technology practitioners seek a balance between optimum ovarian stimulation and successful treatment outcome with minimal rate of severe ovarian hyperstimulation syndrome (OHSS) or multiple pregnancies. However, despite many years of clinical experience, there are no precise methods to completely prevent severe OHSS, except by withholding the ovulation-inducing trigger of hCG. Individualization of treatment according to the specific risk factor and the specific response in the current cycle with the option of freezing of all embryos, or replacement of only a single embryo, has the potential of reducing the risk and the severity of the syndrome in susceptible cases. We offer a triage aimed at eliminating the occurrence of severe ovarian hyperstimulation syndrome on the basis of several clinical observations, including the role of GnRH antagonist in controlled ovarian stimulation protocols, the option of freezing of all embryos, or replacement of only a single embryo in the blastocyst stage.