What do systematic reviews say?

hCG vs placebo/no treatment

hCG may leads to higher OHSS compared with placebo/no treatment (low certainty).

• Luteal phase support for assisted reproduction cycles 2015 · Cochrane Headline outcomes only
  OR 4.28 [1.91, 9.6]
  1 study · 387 participants
  Low

RhCG vs uhCG

RhCG showed no clear difference in OHSS per woman ‐ moderate to severe OHSS compared with uhCG (low certainty).

• Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles 2016 · Cochrane Headline outcomes only
  OR 1.76 [0.37, 8.45]
  3 studies · 417 participants
  Low

hCG vs GnRH agonist

hCG showed no clear difference in OHSS per cycle compared with gnRH‐a (low certainty).

• Synchronised approach for intrauterine insemination in subfertile couples 2014 · Cochrane Headline outcomes only
  OR 2.27 [0.65, 7.91]
  3 studies · 456 participants
  Low

u‐hCG vs r‐hCG

• Synchronised approach for intrauterine insemination in subfertile couples 2014 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 468 participants
  Moderate

Low‐dose hCG vs FSH throughout the COH

It is very uncertain whether low‐dose hCG changes OHSS compared with FSH throughout the COH (very low certainty).

• FSH replaced by low‐dose hCG in the late follicular phase versus continued FSH for assisted reproductive techniques 2013 · Cochrane Headline outcomes only
  OR 0.3 [0.06, 1.59]
  5 studies · 351 participants
  Very low

Coasting vs follicle stimulating hormone administration at time of hCG

It is very uncertain whether coasting changes OHSS compared with follicle stimulating hormone administration at time of hCG (very low certainty).

• Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome 2017 · Cochrane Headline outcomes only
  OR 43.74 [2.54, 754.58]
  1 study · 102 participants
  Very low

Progesterone vs hCG regimens

Progesterone may leads to lower OHSS compared with hCG regimens (low certainty).

• Luteal phase support for assisted reproduction cycles 2015 · Cochrane Headline outcomes only
  OR 0.46 [0.3, 0.71]
  5 studies · 1293 participants
  Low

GnRH agonists vs HCG

GnRH agonist probably leads to lower OHSS (moderate or severe): overall risk compared with HCG (moderate certainty).

• Gonadotropin‐releasing hormone agonist versus HCG for oocyte triggering in antagonist‐assisted reproductive technology 2014 · Cochrane Headline outcomes only
  OR 0.21 [0.07, 0.66]
  8 studies · 989 participants
  Moderate

GnRH agonists vs HCG

GnRH agonist probably leads to lower OHSS (mild, moderate or severe): overall risk compared with HCG (moderate certainty).

• Gonadotropin‐releasing hormone agonist versus HCG for oocyte triggering in antagonist‐assisted reproductive technology 2014 · Cochrane Headline outcomes only
  OR 0.15 [0.05, 0.47]
  8 studies · 989 participants
  Moderate

GnRH agonists vs HCG

GnRH agonist probably leads to lower OHSS (mild, moderate or severe) in women at high risk of OHSS compared with HCG (moderate certainty).

• Gonadotropin‐releasing hormone agonist versus HCG for oocyte triggering in antagonist‐assisted reproductive technology 2014 · Cochrane Headline outcomes only
  OR 0.06 [0.01, 0.34]
  3 studies · 212 participants
  Moderate

RhLH vs uhCG

It is very uncertain whether rhLH changes OHSS per woman ‐ Moderate OHSS compared with uhCG (very low certainty).

• Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in IVF and ICSI cycles 2016 · Cochrane Headline outcomes only
  OR 0.83 [0.4, 1.7]
  2 studies · 289 participants
  Very low