{"id":7350,"date":"2026-06-20T02:16:12","date_gmt":"2026-06-20T02:16:12","guid":{"rendered":"https:\/\/gothi.gov.eg\/?page_id=7350"},"modified":"2026-06-20T02:22:31","modified_gmt":"2026-06-20T02:22:31","slug":"%d8%aa%d9%82%d9%86%d9%8a%d8%a7%d8%aa-%d8%a7%d9%84%d8%a5%d8%ae%d8%b5%d8%a7%d8%a8-%d8%a7%d9%84%d9%85%d8%b3%d8%a7%d8%b9%d8%af","status":"publish","type":"page","link":"https:\/\/gothi.gov.eg\/?page_id=7350","title":{"rendered":"\u062a\u0642\u0646\u064a\u0627\u062a \u0627\u0644\u0625\u062e\u0635\u0627\u0628 \u0627\u0644\u0645\u0633\u0627\u0639\u062f"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7350\" class=\"elementor elementor-7350\" data-elementor-settings=\"{&quot;element_pack_global_tooltip_width&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true}}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-046e64a e-flex e-con-boxed e-con e-parent\" data-id=\"046e64a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6d86f09 elementor-widget__width-initial elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"6d86f09\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation_delay&quot;:250,&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u062a\u0642\u0646\u064a\u0627\u062a \u0627\u0644\u0625\u062e\u0635\u0627\u0628 \u0627\u0644\u0645\u0633\u0627\u0639\u062f\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-87a715c ui-e-animation-acc-basic ui-e-animation-ico-fade elementor-widget elementor-widget-uicore-accordion\" data-id=\"87a715c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;collapsible&quot;:&quot;true&quot;,&quot;active_hash&quot;:&quot;no&quot;,&quot;accordion_animation&quot;:&quot;ui-e-animation-acc-basic&quot;}\" data-widget_type=\"uicore-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"ui-e-accordion\" >\n\n                            <div class=\"ui-e-accordion-item ui-e-item ui-open\" role=\"button\" tabindex=\"0\" aria-expanded=\"true\" aria-controls=\"ui-e-acc-1\" id=\"ui-e-artificial-oocyte-activation-aoa-following-intracytoplasmic-sperm-injection-icsi\">\n\n                    <h5 class=\"ui-e-accordion-title ui-e-title ui-right\">\n\n                                                    <span class=\"ui-e-accordion-icon ui-e-icon ui-e-right\" aria-hidden=\"true\">\n\n                                <span class=\"ui-e-accordion-icon-closed\">\n                                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg>                                <\/span>\n\n                                                                    <span class=\"ui-e-accordion-icon-opened\">\n                                        <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg>                                    <\/span>\n                                \n                            <\/span>\n                        \n                                                <span class=\"ui-e-accordion-title-text ui-e-title-text\" >\n                                                        Artificial Oocyte Activation (AOA) Following Intracytoplasmic Sperm Injection (ICSI)                        <\/span>\n\n                    <\/h5>\n\n                    <div class=\"ui-e-accordion-content ui-e-content\" style=\"\" aria-labelledby=\"ui-e-artificial-oocyte-activation-aoa-following-intracytoplasmic-sperm-injection-icsi\" id=\"ui-e-acc-1\">\n                        <h4 id=\"yui_3_18_1_1_1781920123470_25\"><span id=\"yui_3_18_1_1_1781920123470_24\"><strong id=\"yui_3_18_1_1_1781920123470_23\">\u00a0 \u00a0\u00a0<a id=\"yui_3_18_1_1_1781920123470_22\" href=\"https:\/\/lms.ehc.gov.eg\/lms\/pluginfile.php\/888\/mod_book\/intro\/Artificial%20Oocyte%20Activation%20%28AOA%29%20Following%20Intracytoplasmic%20Sperm%20Injection%20%28ICSI%29.pdf\" target=\"_blank\" rel=\"noopener\"><u id=\"yui_3_18_1_1_1781920123470_21\"><strong id=\"yui_3_18_1_1_1781920123470_20\">Download Guideline<\/strong><\/u><\/a><\/strong><\/span><\/h4><h3 id=\"yui_3_18_1_1_1781920659685_20\" class=\" ccnMdlHeading\">&#8211; Executive Summary<\/h3><div class=\"no-overflow\"><p align=\"left\">\u25aa\ufe0f\u00a0 IVF facilities could consider offering AOA for patients with previous no or low fertilisation, defined as lower than 30% (conditional recommendation).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0AOA could be considered after proper counselling and well-informing the patients of globozoospermia cases (conditional recommendation).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0IVF facilities should NOT recommend AOA for the general ICSI population (conditional recommendation against).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0IVF facilities should NOT recommend AOA for improving embryo quality (conditional recommendation against).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0IVF facilities should NOT recommend AOA for improving embryo development and blastocyst formation (conditional recommendation against).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0IVF facilities should NOT recommend rescue AOA either hours or on day 1 after ICSI (conditional recommendation against).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0IVF facilities could consider sibling-oocyte-split if AOA is offered for patients of previous low or no fertilisation, given the scarce long-term safety data (good practice statment).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0Except for globozoospermia cases, IVF facilities should NOT recommend AOA for ICSI cycle with male factor infertility and no history of no or low fertilisation (conditional recommendation against).<\/p><p align=\"left\">\u25aa\ufe0f\u00a0\u00a0Except for the above recommendations, AOA should only be considered within a research context without charging the patients and after proper counselling and written consent (good practice statment).<\/p><\/div>                    <\/div>\n\n                <\/div>\n                            <div class=\"ui-e-accordion-item ui-e-item\" role=\"button\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"ui-e-acc-2\" id=\"ui-e-the-embryos-to-transfer-in-ivf-icsi\">\n\n                    <h5 class=\"ui-e-accordion-title ui-e-title ui-right\">\n\n                                                    <span class=\"ui-e-accordion-icon ui-e-icon ui-e-right\" aria-hidden=\"true\">\n\n                                <span class=\"ui-e-accordion-icon-closed\">\n                                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg>                                <\/span>\n\n                                                                    <span class=\"ui-e-accordion-icon-opened\">\n                                        <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg>                                    <\/span>\n                                \n                            <\/span>\n                        \n                                                <span class=\"ui-e-accordion-title-text ui-e-title-text\" >\n                                                        The Embryos to Transfer in IVF\/ICSI                        <\/span>\n\n                    <\/h5>\n\n                    <div class=\"ui-e-accordion-content ui-e-content\" style=\"display:none;\" aria-labelledby=\"ui-e-the-embryos-to-transfer-in-ivf-icsi\" id=\"ui-e-acc-2\">\n                        <div class=\"ccn-4-navigation container\"><div class=\"secondary-navigation\"><nav class=\"moremenu navigation observed\"><ul id=\"moremenu-6a35f406ed674-nav-tabs\" class=\"nav more-nav nav-tabs\" role=\"menubar\"><li class=\"nav-item\" role=\"none\" data-key=\"modulepage\" data-forceintomoremenu=\"false\"><div id=\"mod_book-chapter\" class=\"box py-3 generalbox book_content\"><h4 id=\"yui_3_18_1_1_1781920123470_25\"><span id=\"yui_3_18_1_1_1781920123470_24\"><strong id=\"yui_3_18_1_1_1781920123470_23\">\u00a0 \u00a0\u00a0<a id=\"yui_3_18_1_1_1781920123470_22\" href=\"https:\/\/lms.ehc.gov.eg\/lms\/pluginfile.php\/876\/mod_book\/intro\/embryo%20guidelines%20version%207%20%283%29.pdf\" target=\"_blank\" rel=\"noopener\"><u id=\"yui_3_18_1_1_1781920123470_21\"><strong id=\"yui_3_18_1_1_1781920123470_20\">Download Guideline<\/strong><\/u><\/a><\/strong><\/span><\/h4><p>&#8211; Executive Summary<\/p><div class=\"no-overflow\"><p>\u25cf\u00a0<strong>It is recommended that clinicians should perform single embryo transfer (strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Medical SET is indicated for women in whom multiple pregnancy represents an a priori increased risk compared to the overall population such as women with congenital uterine anomalies (e.g. septate uterus), bad obstetric history (e.g. previous premature birth &lt;32 gestational weeks) and severe systemic diseases (e.g. insulin-dependent diabetes).(strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Elective single embryo transfer should be used in cases with PGTA<sup>\u00a0<\/sup>(strong recommendation)<sup>\u00a0<\/sup>.<\/strong><\/p><p>\u25cf\u00a0<strong>It is recommended to encourage eSET in good-prognosis patients although a maximum of two embryos is allowed after proper counseling. In cases of DET, a written consent explaining the risks of multiple pregnancies should be signed. (conditional recommendation).<\/strong><\/p><p><strong><u>\u27a1\ufe0fGood prognosis patients include:<\/u><\/strong><\/p><div class=\"editor-indent\"><p>&#8211;\u00a0\u00a0First or second IVF attempt whether fresh or frozen ET and excellent embryo quality by morphology. It should be emphasized that DET may have in most studies a higher LBR compared to eSET, but this is at the expense of significantly higher MPR. The higher MPR with DET is a consistent finding whether the embryos are fresh or frozen, cleavage stage or blastocysts, good-quality or mixed (one good &amp; one poor-quality) or two poor-quality embryos.<sup>16-21<\/sup><\/p><p>&#8211;\u00a0\u00a0Surplus embryos of sufficient quality to warrant cryopreservation, or in cases of FET, the availability of vitrified high-quality day 5 or day 6 blastocysts for transfer.<sup>22<\/sup><\/p><p>&#8211;\u00a0\u00a0Previously pregnancy\/live birth particularly if resulting from IVF. This is associated with an increased chance of LBR and MPR.<sup>23,27<\/sup>\u00a0Other studies confirmed the association of previous pregnancy with LBR but with no correlation with MPR.<sup>27,30<\/sup><\/p><\/div><p>\u25cf\u00a0<strong>Females &lt;38 years of age should be strongly encouraged to transfer one embryo especially if they meet the criteria of good prognosis. Emphasis on eSET is highly recommended if the female age is &lt;35 years<sup>\u00a0<\/sup>\u00a0(strong recommendation).<\/strong><\/p><p>\u25cf\u00a0\u00a0<strong>Females between 38 and 40 years are allowed to transfer two embryos, however, eSET can still be encouraged especially if they have good prognosis. (strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Females 41-42 years of age should receive no more than two embryos. (strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>In FET cycles, the decisions should be based on the age of the woman when the embryos were cryopreserved. (strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Trans-abdominal\u00a0 ultrasound guidance during embryo transfer is recommended as it improves clinical pregnancy rate and live-birth rate. (strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>It is\u00a0 recommended to use a soft embryo transfer catheter as it improves the pregnancy rate in fresh and Frozen cycles. (strong\u00a0 recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Anesthesia during embryo transfer\u00a0 does not improve pregnancy rates. Given that there are added risks associated with anesthesia, routine anesthesia is not recommended in IVF-embryo transfer. ( strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>It is recommended to place\u00a0 the catheter tip in the upper or middle (central) area of the uterine cavity, greater than 1\u00a0cm from the fundus as this decreases embryo expulsion and optimizes pregnancy rates. (Conditional recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>It is not recommended to prescribe antibiotics with embryo transfer. (conditional\u00a0 recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>Bed rest is not recommended after embryo transfer as it does not increase pregnancy rates (Strong recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>No enough evidence to recommend routine removal of cervical mucous from the cervix before embryo transfer (conditional recommendation).<\/strong><\/p><p>\u25cf\u00a0<strong>There is No specific time to recommend removal of\u00a0\u00a0 the embryo transfer catheter after embryo transfer. (conditional recommendation).<\/strong><\/p><\/div><\/div><div class=\"mt-5 mb-5 activity-navigation\"><div class=\"row\"><div class=\"col-md-4\"><div class=\"float-left ui_kit_btn\">\u00a0<\/div><\/div><div class=\"col-md-4\"><div class=\"mdl-align\"><div class=\"urlselect\">\u00a0<\/div><\/div><\/div><\/div><\/div><\/li><\/ul><\/nav><\/div><\/div>                    <\/div>\n\n                <\/div>\n                            <div class=\"ui-e-accordion-item ui-e-item\" role=\"button\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"ui-e-acc-3\" id=\"ui-e-prevention-and-management-of-ovarian-hyperstimulation-syndrome-ohss\">\n\n                    <h5 class=\"ui-e-accordion-title ui-e-title ui-right\">\n\n                                                    <span class=\"ui-e-accordion-icon ui-e-icon ui-e-right\" aria-hidden=\"true\">\n\n                                <span class=\"ui-e-accordion-icon-closed\">\n                                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg>                                <\/span>\n\n                                                                    <span class=\"ui-e-accordion-icon-opened\">\n                                        <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg>                                    <\/span>\n                                \n                            <\/span>\n                        \n                                                <span class=\"ui-e-accordion-title-text ui-e-title-text\" >\n                                                        Prevention and Management of Ovarian Hyperstimulation Syndrome (OHSS)                        <\/span>\n\n                    <\/h5>\n\n                    <div class=\"ui-e-accordion-content ui-e-content\" style=\"display:none;\" aria-labelledby=\"ui-e-prevention-and-management-of-ovarian-hyperstimulation-syndrome-ohss\" id=\"ui-e-acc-3\">\n                        <div id=\"mod_book-chapter\" class=\"box py-3 generalbox book_content\"><h4 id=\"yui_3_18_1_1_1781920123470_25\"><span id=\"yui_3_18_1_1_1781920123470_24\"><strong id=\"yui_3_18_1_1_1781920123470_23\">\u00a0 \u00a0\u00a0<a id=\"yui_3_18_1_1_1781920123470_22\" href=\"https:\/\/lms.ehc.gov.eg\/lms\/pluginfile.php\/1322\/mod_book\/intro\/Prevention%20and%20Management%20of%20Ovarian%20Hyperstimulation%20Syndrome%20%28OHSS%29.pdf\" target=\"_blank\" rel=\"noopener\"><u id=\"yui_3_18_1_1_1781920123470_21\"><strong id=\"yui_3_18_1_1_1781920123470_20\">Download Guideline<\/strong><\/u><\/a><\/strong><\/span><\/h4><p>&#8211; Executive Summary<\/p><div class=\"no-overflow\"><p><span lang=\"EN-GB\">\u00b7\u00a0 \u00a0<\/span><span lang=\"EN-GB\">It is recommended to counsel patients with elevated anti-m\u00fcllerian hormone levels, polycystic ovary syndrome (PCOS), and anticipated high oocyte yields that they are at increased risk for ovarian hyperstimulation syndrome (OHSS). Interventions to reduce OHSS risk should be focused on this patient population.<\/span><\/p><p><span lang=\"EN-GB\">(Strong Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0 \u00a0<\/span><span lang=\"EN-GB\">It is recommended to dose gonadotropins based on individualized ovarian reserve testing to decrease the risk of OHSS (Strong Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Consider\u00a0<\/span><span lang=\"EN-GB\">lowering<\/span><span lang=\"EN-GB\">\u00a0the starting dose of gonadotropins and\/or supplementing with oral ovulation-inducing medications (clomiphene citrate and\/or letrozole) to decrease the risk of OHSS (<\/span><span lang=\"EN-GB\">Conditional Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Use a GnRH agonist to trigger oocyte maturation as a first-line strategy to reduce\u00a0<\/span><span lang=\"EN-GB\">the risk of moderate-to-severe OHSS (Strong Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Coasting is generally not recommended as a primary strategy to reduce the risk of moderate-to-severe OHSS. However, when other more effective strategies are not available, coasting in combination with cabergoline and a freeze-only strategy may mitigate the risk (Conditional recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Provid<\/span><span lang=\"EN-GB\">e adequate luteal support when using a GnRH agonist as a trigger and planning a fresh embryo transfer (<\/span><span lang=\"EN-GB\">Strong Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">In patients at risk for moderate-to-severe OHSS, start a dopamine agonist such as cabergoline on the day of the hCG trigger or soon after that and continue for several days (<\/span><span lang=\"EN-GB\">Strong Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Consider a freeze-only cycle and subsequent frozen embryo transfer in patients at risk for OHSS based on a high ovarian response or elevated serum estradiol levels. Multiple high-quality studies have reported a significant reduction in rates of moderate or severe OHSS when this strategy is employed (<\/span><span lang=\"EN-GB\">Strong Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not use a lower dose for the human chorionic gonadotropin (hCG)-only trigger as a strategy to reduce the risk of moderate-to-severe OHSS (<\/span><span lang=\"EN-GB\">Conditional Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not administer letrozole as an intervention to reduce rates of moderate-to-severe OHSS (<\/span><span lang=\"EN-GB\">Conditional Recommendation<\/span><span lang=\"EN-GB\">).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not\u00a0<\/span><span lang=\"EN-GB\">administer a luteal GnRH antagonist alone to reduce rates of moderate-to-severe OHSS. Most studies report no reduction in rates of moderate-to-severe OHSS or associated signs or symptoms. Some low-quality evidence suggests modest symptomatic improvement in women with OHSS who received a GnRH antagonist after the hCG trigger (Conditional Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not use aspirin as a primary strategy to reduce the incidence of OHSS (Conditional Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not administer metformin for the sole purpose of reducing the incidence of OHSS in GnRH antagonist cycles. Most studies do not report a significant reduction in OHSS rates in women with PCOS who were given metformin. However, metformin may be considered for OHSS risk reduction among women with PCOS using a GnRH-agonist protocol (Conditional Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not administer medications such as mifepristone, myoinositol, D-chiro-inositol, or glucocorticoids to reduce rates of OHSS as studies have shown these interventions to be ineffective (Conditional Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span><span lang=\"EN-GB\">Do not use volume expanders such as albumin, hydroxyethyl starch, or mannitol in patients at high risk of developing moderate or severe OHSS (Conditional Recommendation).<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0<\/span><span lang=\"EN-GB\">Clinicians need to be aware of the symptoms and signs of OHSS, as the diagnosis is based on clinical criteria. (Conditional Recommendation). Table 4<\/span><\/p><p>\u00b7\u00a0<span lang=\"EN-GB\">Women presenting with symptoms suggestive of OHSS should be assessed face-to-face by a clinician. In women presenting with severe abdominal pain or pyrexia, extr<\/span>a care should be taken to rule out other causes of the patient\u2019s symptoms. The input of clinicians experienced in the management of OHSS should be obtained in such cases. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p><span lang=\"EN-GB\">\u00b7\u00a0\u00a0<\/span>It is recommended that once the diagnosis of OHSS is established, the severity of the disease should be classified as mild, moderate, severe, or critical\u00a0<span lang=\"EN-GB\">according to the standardized classification scheme included. (Conditional Recommendation). Table 5<\/span><\/p><p><span lang=\"EN-GB\">\u00b7\u00a0<\/span><span lang=\"EN-GB\">Outpatient management is recommended for women who have mild or moderate OHSS and only in selected cases with severe OHSS when the physician can ensure that the patient can follow clinical guidelines and ensure that a system is in place to assess the condition every 1 to 2 days. (Conditional Recommendation).<\/span><\/p><p>\u00b7\u00a0<span lang=\"EN-GB\">Women undergoing outpatient management of OHSS should be appropriately counselled and provided with information regarding fluid intake and output monitoring. In<\/span>\u00a0addition, they should be provided with contact details to access advice. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0Fluid replacement by the oral route, guided by thirst, is the most physiological approach to correcting intravascular dehydration. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0Women with moderate OHSS should be evaluated for predisposing risk factors for thrombosis and prescribed either antiembolism stockings or LMWH if indicated. (Conditional<span lang=\"EN-GB\">\u00a0Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Women with severe OHSS being managed on an outpatient basis should receive thromboprophylaxis with low molecular weight heparin (LMWH). The duration of treatment should be individualised, taking into account risk factors and whether or not conception occurs. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Women with OHSS being managed on an outpatient basis should be reviewed urgently if they develop symptoms or signs of worsening OHSS. In the absence of these, a review every 2\u20133 days is likely to be adequate. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Baseline\u00a0<span lang=\"EN-GB\">laboratory<\/span>\u00a0investigations should be repeated if the severity of OHSS is thought to be worsening. Haematocrit is a useful guide to the degree of intravascular volume depletion. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>) Table 6<\/p><p>\u00b7\u00a0\u00a0Outpatient paracentesis\/culdocentesis of ascitic fluid by the abdominal or transvaginal route under ultrasound guidance may be considered for prevention of disease progression in cases of moderate to severe OHSS. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Hospital admission should be considered for women who:<\/p><p>\u00b7\u00a0 \u00a0are unable to achieve satisfactory pain control<\/p><p>\u00b7\u00a0\u00a0are unable to maintain adequate fluid intake due to nausea<\/p><p>\u00b7\u00a0\u00a0show signs of worsening OHSS despite outpatient intervention<\/p><p>\u00b7\u00a0\u00a0are unable to attend for regular outpatient follow-up<\/p><p>\u00b7\u00a0\u00a0have critical OHSS.<br \/>(<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Women with severe and critical OHSS should be hospitalized for intravenous hydration and observation. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0Intravenous hydration with crystalloid solution should be implemented to prevent hemoconcentration and provide adequate organ perfusion targets. When the use of a crystalloid solution does not allow the maintenance of such an infusion, an alternative colloidal solution should be administered. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Women admitted with OHSS should be assessed at least once daily. More frequent assessment is appropriate for women with critical OHSS and those with complications. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Antiemetics may be used in women with OHSS, avoiding medicines contraindicated in pregnancy. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Women with persistent haemoconcentration despite volume replacement with intravenous colloids may need invasive monitoring, and this should be managed with anaesthetic input. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>) (40).<\/p><p>\u00b7\u00a0\u00a0Features of critical OHSS should prompt consideration of the need for intensive care. Multidisciplinary assistance should be sought\u00a0<span lang=\"EN-GB\">for<\/span>\u00a0the care of women with critical OHSS and severe OHSS who have persistent haemoconcentration and dehydration. A clinician experienced in the management of OHSS should remain in overall charge of the woman\u2019s care. Intravenous colloid therapy should be considered for women who have large volumes of fluid removed by paracentesis. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0In hospitalized patients, pain relief should be conducted with acetaminophen and\/or opioid analgesics. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0\u00a0Prophylactic doses of anticoagulants should be considered in women who have severe ovarian hyperstimulation syndrome. The duration of LMWH prophylaxis should be individualized according to patient risk factors and outcome of treatment. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00b7\u00a0Paracentesis should be performed to alleviate discomfort in hospitalized patients with tense ascites. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p><strong><u>Indications for paracentesis include the following:<\/u><\/strong><\/p><p>&#8211;\u00a0 \u00a0severe abdominal distension and abdominal pain secondary to ascites<\/p><p>&#8211;\u00a0\u00a0shortness of breath and respiratory compromise secondary to ascites and increased intra-abdominal pressure<\/p><p>&#8211;\u00a0\u00a0oliguria despite adequate volume replacement, secondary to increased abdominal pressure causing reduced renal perfusion.<\/p><p>\u00b7\u00a0\u00a0In addition to the\u00a0<span lang=\"EN-GB\">usual<\/span>\u00a0symptoms and signs of venous thromboembolism (VTE), thromboembolism should be suspected in women with OHSS who present with unusual neurological symptoms, even if they present several weeks after apparent improvement in OHSS. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0Surgery is only indicated in patients with OHSS if there is a coincident problem such as adnexal torsion, ovarian rupture, or ectopic pregnancy, and should be performed by an experienced surgeon. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0Non-steroidal anti-inflammatory drugs with antiplatelet properties shouldn&#8217;t be used for pain relief as they may compromise renal function. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0Diuretics should be avoided as they further deplete intravascular volume, but they may have a role in a multidisciplinary setting if oliguria persists despite adequate fluid replacement and drainage of ascites. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>)<\/p><p>\u00b7\u00a0\u00a0There is insufficient evidence to support the use of gonadotrophin-releasing hormone antagonists\u00a0<span lang=\"EN-GB\">or<\/span>\u00a0dopamine agonists in treating established OHSS. Those drugs should not be used as routine management of OHSS. (<span lang=\"EN-GB\">Conditional Recommendation<\/span>).<\/p><p>\u00a0<\/p><\/div><\/div><div class=\"mt-5 mb-5 activity-navigation\"><div class=\"row\"><div class=\"col-md-4\"><div class=\"float-left ui_kit_btn\">\u00a0<\/div><\/div><div class=\"col-md-4\"><div class=\"mdl-align\"><div class=\"urlselect\"><label class=\"sr-only\" for=\"jump-to-activity\">Jump to activity<\/label><\/div><\/div><\/div><\/div><\/div>                    <\/div>\n\n                <\/div>\n                    <\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u062a\u0642\u0646\u064a\u0627\u062a \u0627\u0644\u0625\u062e\u0635\u0627\u0628 \u0627\u0644\u0645\u0633\u0627\u0639\u062f Artificial Oocyte Activation (AOA) Following Intracytoplasmic Sperm Injection (ICSI) \u00a0 \u00a0\u00a0Download Guideline &#8211; Executive Summary \u25aa\ufe0f\u00a0 IVF facilities could [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7350","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7350","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7350"}],"version-history":[{"count":7,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7350\/revisions"}],"predecessor-version":[{"id":7357,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7350\/revisions\/7357"}],"wp:attachment":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7350"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}