Background: IVF is an effective treatment for infertility, however it may be complicated by the potentially life-threatening ovarian hyperstimulation syndrome (OHSS). OHSS is an iatrogenic condition, resultant on the mode of triggering oocyte maturation. Kisspeptin safely triggers oocyte maturation in women at high risk of OHSS, but has yet to be compared with current triggers of oocyte maturation (hCG or GnRH agonist).
Methods: We compared parameters of early OHSS (2-5 days after oocyte retrieval) after different triggers of oocyte maturation (hCG, GnRH-agonist or kisspeptin) in women at high risk of OHSS at Hammersmith Hospital, London, UK between 2013-2016. Inclusion criteria included antral follicle count $23, age <35 yrs, BMI <30 kg/m2 and both ovaries intact. Participants received either kisspeptin (n=115), GnRH-agonist (GnRHa) (n=94) or hCG (n=22) to trigger oocyte maturation. OHSS screening comprised of sonographic measurements (ascitic fluid and ovarian volume), OHSS symptoms and biochemical parameters. Groups were compared using one-way ANOVA with post-hoc Bonferroni correction.
Results: OHSS symptoms were least frequent following kisspeptin, and most frequent after hCG triggering: abdominal pain occurred in 80% of patients after hCG, 22% after GnRHa, but only 12% after kisspeptin. Vomiting was also most frequent following hCG (10%) and least common following kisspeptin (1%). Mean ovarian volume (±SD) 3-5 days following oocyte retrieval was significantly larger following hCG (192±97 mls) than GnRHa (53±37 mls; P<0.0001), and significantly smaller still following kisspeptin (9±4 mls; P<0.0001), suggesting ovarian recovery is most rapid following kisspeptin. Mean ascitic volume (102±150 mls) was greater following hCG triggering than after either GnRHa (5.8±22 mls), or kisspeptin (4.6±7.8 mls; P<0.0001).
Conclusion: We observe that signs and symptoms of OHSS are significantly less common following kisspeptin triggering than either hCG or GnRH agonist in a population at high risk of OHSS. Kisspeptin may thus offer a safer therapeutic option to trigger oocyte maturation particularly in women at high risk of OHSS.