One of the methods to reduce the risk of ovarian hyperstimulation syndrome (OHSS) in high responders is to modify the trigger medication by decreasing HCG dosing or administering GnRH-agonist trigger alone or combined with low dose HCG. However, patients with hypothalamic amenorrhea or those undergoing stimulation with GnRH-agonist protocol are not candidates for GnRH-agonist trigger. Therefore, such patients have to be triggered with HCG.
