@article{c7ba7798d9e7448bb07b145bc76ddb3b,
title = "The HERA (Hyper-response Risk Assessment) Delphi consensus for the management of hyper-responders in in vitro fertilization",
abstract = "Purpose: 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. Results: 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). Conclusion: These guidelines for the management of hyper-response can be useful for tailoring patient care and for harmonizing future research.",
keywords = "Hyper-response, Ovarian hyperstimulation syndrome, Ovarian stimulation",
author = "I. Feferkorn and S. Santos-Ribeiro and Ubaldi, {F. M.} and Velasco, {J. G.} and B. Ata and C. Blockeel and A. Conforti and Esteves, {S. C.} and Fatemi, {H. M.} and L. Gianaroli and M. Grynberg and P. Humaidan and Lainas, {G. T.} and {La Marca}, A. and C. LaTasha and R. Lathi and Norman, {R. J.} and R. Orvieto and R. Paulson and A. Pellicer and Polyzos, {N. P.} and M. Roque and Sunkara, {S. K.} and Tan, {S. L.} and B. Urman and C. Venetis and A. Weissman and H. Yarali and Dahan, {M. H.}",
note = "Publisher Copyright: {\textcopyright} 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
year = "2023",
month = nov,
doi = "10.1007/s10815-023-02918-5",
language = "אנגלית",
volume = "40",
pages = "2681--2695",
journal = "Journal of Assisted Reproduction and Genetics",
issn = "1058-0468",
publisher = "Springer New York",
number = "11",
}