Severe ovarian hyperstimulation syndrome following gonadotropin releasing hormone agonist trigger and freeze all approach in GnRH antagonist protocol

Two case reports are presented, in which GnRH triggering and the freeze-all approach in a GnRH antagonist protocol resulted in the development of severe OHSS, requiring hospitalization and peritoneal drainage.

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Human Mousavi Fatemi, M.D., Ph.D., Biljana Popovic-Todorovic, M.D., Ph.D., Peter Humaidan, M.D., D.M.Sc., Shahar Kol, M.D., Ph.D., Manish Banker, M.D., Paul Devroey, M.D., Ph.D., Juan Antonio García-Velasco, M.D., Ph.D.

Volume 101, Issue 4, Pages 1008-1011



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.


Two case reports.


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


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


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.


Complete recovery.


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.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

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