Dosage of the trigger

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.