Severe Ovarian Hyperstimulation Syndrome After Gonadotropin-releasing Hormone (GnRH) Agonist Trigger and "freeze-all" Approach in GnRH Antagonist Protocol

Objective: To report two cases with GnRH agonist triggering and a freeze-all approach in a GnRH antagonist protocol resulting in the development of severe ovarian hyperstimulation syndrome (OHSS), requiring hospitalization and peritoneal drainage.

Design: Two case reports.

Setting: A tertiary referral center and an obstetrics and gynecology department of a hospital.

Patient(s): Case 1 and case 2: severe OHSS with abdominal distension, ascites development, and hemoconcentration.

Intervention(s): Case 1 and case 2: diagnosed by clinical, hematologic, and ultrasound findings. Hospitalization, IV infusion, and peritoneal drainage.

Main Outcome Measure(s): Symptomatic treatment and prevention of further complication.

Result(s): Complete recovery.

Conclusion(s): Two cases of severe OHSS after GnRH agonist trigger in a GnRH antagonist protocol without the administration of any hCG for luteal-phase support. Clinicians have to be aware that even the sequential approach to ovarian stimulation with a freeze-all attitude does not completely eliminate OHSS in all patients.