The HERA (Hyper-response Risk Assessment) Delphi consensus for the management of hyper-responders in in vitro fertilization.

Female Humans Pregnancy Ovarian Hyperstimulation Syndrome Consensus Delphi Technique Gonadotropin-Releasing Hormone Chorionic Gonadotropin Fertilization in Vitro / methods Ovulation Induction / methods Risk Assessment Pregnancy Rate
Hyper-response Ovarian hyperstimulation syndrome Ovarian stimulation

Journal

Journal of assisted reproduction and genetics
ISSN: 1573-7330
Titre abrégé: J Assist Reprod Genet
Pays: Netherlands
ID NLM: 9206495

Informations de publication

Date de publication:
Nov 2023
Historique:
received: 29 03 2023
accepted: 15 08 2023
pmc-release: 01 11 2024
medline: 15 11 2023
pubmed: 15 9 2023
entrez: 15 9 2023
Statut: ppublish

Résumé

To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS) METHODS: A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori, it was decided that consensus would be reached when ≥66% of the participants agreed, and ≤3 rounds would be used to obtain this consensus. A total of 28/31 experts responded (selected for global coverage), anonymous to each other. A total of 26/28 statements reached consensus. The most relevant are summarized here. The target number of oocytes to be collected in a stimulation cycle for IVF in an anticipated hyper-responder is 15-19 (89.3% consensus). For a potential hyper-responder, it is preferable to achieve a hyper-response and freeze all than aim for a fresh transfer (71.4% consensus). GnRH agonists should be avoided for pituitary suppression in anticipated hyper-responders performing IVF (96.4% consensus). The preferred starting dose in the first IVF stimulation cycle of an anticipated hyper-responder of average weight is 150 IU/day (82.1% consensus). ICoasting in order to decrease the risk of OHSS should not be used (89.7% consensus). Metformin should be added before/during ovarian stimulation to anticipated hyper-responders only if the patient has PCOS and is insulin resistant (82.1% consensus). In the case of a hyper-response, a dopaminergic agent should be used only if hCG will be used as a trigger (including dual/double trigger) with or without a fresh transfer (67.9% consensus). After using a GnRH agonist trigger due to a perceived risk of OHSS, luteal phase rescue with hCG and an attempt of a fresh transfer is discouraged regardless of the number of oocytes collected (72.4% consensus). The choice of the FET protocol is not influenced by the fact that the patient is a hyper-responder (82.8% consensus). In the cases of freeze all due to OHSS risk, a FET cycle can be performed in the immediate first menstrual cycle (92.9% consensus). These guidelines for the management of hyper-response can be useful for tailoring patient care and for harmonizing future research.

Identifiants

DOI: 10.1007/s10815-023-02918-5 PMID: 37713144 PMC: PMC10643792
pubmed: 37713144
doi: 10.1007/s10815-023-02918-5
pii: 10.1007/s10815-023-02918-5
pmc: PMC10643792
doi:

Substances chimiques

Gonadotropin-Releasing Hormone 33515-09-2
Chorionic Gonadotropin 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2681-2695

Commentaires et corrections

Type : ErratumIn

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Auteurs

I Feferkorn (I)

IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. idofeferkon@gmail.com.
ORCID: 0000-0002-9772-3613

S Santos-Ribeiro (S)

IVI-RMA Lisboa, 1800-282, Lisbon, Portugal.

F M Ubaldi (FM)

GeneraLife Centers for Reproductive Medicine, Rome, Italy.

J G Velasco (JG)

IVI RMA Madrid, Madrid, Spain.

B Ata (B)

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey.
ART Fertility Clinics, Dubai, United Arab Emirates.

C Blockeel (C)

Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium.

A Conforti (A)

Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy.

S C Esteves (SC)

ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado 1464, Campinas, SP, 13075-460, Brazil.
Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil.
Faculty of Health, Aarhus University, C, 8000, Aarhus, Denmark.

H M Fatemi (HM)

ART Fertility Clinics, Abu Dhabi, United Arab Emirates.

L Gianaroli (L)

Società Italiana Studi di Medicina della Riproduzione, S.I.S.Me.R. Reproductive Medicine Institute, Bologna, Emilia-Romagna, Italy.

M Grynberg (M)

Department of Reproductive Medicine, Hôpital Antoine-Béclère, University Paris-Sud (Paris XI), Le Kremlin-Bicêtre, Clamart, France.

P Humaidan (P)

The Fertility Clinic, Skive Regional Hospital, Faculty of Health, Aarhus University, Resenvej 25, 7800, Skive, Denmark.

G T Lainas (GT)

Eugonia IVF Unit, Athens, Greece.

A La Marca (A)

Obstetrics, Gynecology and Reproductive Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, via del Pozzo 71, 41124, Modena, Italy.

L B Craig (LB)

Section of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

R Lathi (R)

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.

R J Norman (RJ)

Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
FertilitySA, Adelaide, South Australia, Australia.
Monash Centre for Health Research and Implementation MCHRI, Monash University, Melbourne, Australia.
NHMRC Centre of Research Excellence in Women's Health in Reproductive Life (CRE-WHiRL), Melbourne, Australia.

R Orvieto (R)

Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

R Paulson (R)

University of Southern California, Los Angeles, CA, 90033, USA.

A Pellicer (A)

Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain.
IVI Roma Parioli, IVI-RMA Global, Rome, Italy.

N P Polyzos (NP)

Department of Reproductive Medicine, Dexeus Mujer, Hospital Universitario Dexeus, Barcelona, Spain.

M Roque (M)

Department of Reproductive Medicine, ORIGEN-Center for Reproductive Medicine, Rio de Janeiro, RJ, Brazil.
Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

S K Sunkara (SK)

Department of Women and Children's Health, King's College London, London, UK.

S L Tan (SL)

OriginElle Fertility Clinic 2110 Boul. Decarie, Montreal, QC, Canada.

B Urman (B)

Department of Obstetrics and Gynecology and Assisted Reproduction, American Hospital, Istanbul, Koc University School of Medicine, Istanbul, Turkey.

C Venetis (C)

Unit for Human Reproduction, 1st Dept of OB/Gyn, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Centre for Big Data Research in Health, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia.
Virtus Health, Sydney, Australia.

A Weissman (A)

In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

H Yarali (H)

Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology, Hacettepe University, School of Medicine, Anatolia IVF and Women's Health Center, Ankara, Turkey.

M H Dahan (MH)

Division of Reproductive Endocrinology and Infertility, McGill University Health Care Center, 888 Boul. de Maisonneuve E #200, Montreal, QC, H2L 4S8, Canada.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Maladies endocriniennes › Troubles gonadiques › Maladies ovariennes › Syndrome d'hyperstimulation ovarienne › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines de tissu nerveux › Neuropeptides › Hormones hypothalamiques › Hormones hypophysiotropes libératrices › Hormone de libération des gonadotrophines › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines de la grossesse › Gonadotrophine chorionique › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Techniques d'investigation › Techniques de reproduction › Techniques de reproduction assistée › Fécondation in vitro › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Techniques d'investigation › Techniques de reproduction › Techniques de reproduction assistée › Induction d'ovulation › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › The HERA (Hyper-response Risk Assessment)...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Taux de grossesse › The HERA (Hyper-response Risk Assessment)...