Stimulation of the high responders and strategies to prevent ovarian hyperstimulation syndrome

Identification of high responder patients is essential prior to ovarian stimulation for in vitro fertilization. These patients usually yield a high number of oocytes (> 15) with high peak estradiol levels (> 3000 pg/ml). Pregnancy and implantation rates are excellent in these patients, but at the expense of a higher risk of ovarian hyperstimulation syndrome (OHSS). Different strategies are reported and discussed with advantages and disadvantages for each. The goal should be an approach that will maintain the good outcome while minimizing the risk of OHSS.