The guideline was developed according to a well-documented methodology that is universal to ESHRE guidelines (Vermeulen et al., 2017 ).
In short, 18 key questions were formulated by the Guideline Development Group (GDG) and structured in PICO format (Patient, Intervention, Comparison, Outcome). For each question, databases (PUBMED/MEDLINE and the Cochrane library) were searched from inception to 8 November 2018, with a limitation to studies written in English. From the literature searches, studies were selected based on the PICO questions, assessed for quality and summarized in evidence tables and summary of findings tables. The critical outcomes for this guideline are efficacy in terms of cumulative live birth rate (CLBR) per started cycle and LBR per started cycle, as well as safety in terms of moderate and/or severe OHSS. GDG meetings were organized where the evidence and draft recommendations were presented by the assigned GDG member and discussed until consensus was reached within the group.
Each recommendation was labelled as strong or conditional and a grade was assigned (Andrews et al., 2013 (link)) based on the strength of the supporting evidence (High ⊕⊕⊕⊕—Moderate ⊕⊕⊕ ⃝—Low ⊕⊕ ⃝ ⃝—Very low ⊕ ⃝ ⃝ ⃝). In the absence of evidence, the GDG formulated no recommendation or a good practice point (GPP) based on clinical expertise (Table I ).
The guideline draft and an invitation to participate in the stakeholder review were published on the ESHRE website. In addition, all relevant stakeholders received a personal invitation to review by e-mail. We received 168 comments from 39 reviewers, representing 21 countries, two national societies (British Fertility Society and working groups from ESHRE). All comments were processed by the GDG, either by adapting the content of the guideline and/or by replying to the reviewer. The review process was summarized in the review report, which is published on the ESHRE website (www.eshre.eu/guidelines ).
This guideline will be considered for update 4 years after publication, with an intermediate assessment of the need for updating 2 years after publication.
In short, 18 key questions were formulated by the Guideline Development Group (GDG) and structured in PICO format (Patient, Intervention, Comparison, Outcome). For each question, databases (PUBMED/MEDLINE and the Cochrane library) were searched from inception to 8 November 2018, with a limitation to studies written in English. From the literature searches, studies were selected based on the PICO questions, assessed for quality and summarized in evidence tables and summary of findings tables. The critical outcomes for this guideline are efficacy in terms of cumulative live birth rate (CLBR) per started cycle and LBR per started cycle, as well as safety in terms of moderate and/or severe OHSS. GDG meetings were organized where the evidence and draft recommendations were presented by the assigned GDG member and discussed until consensus was reached within the group.
Each recommendation was labelled as strong or conditional and a grade was assigned (Andrews et al., 2013 (link)) based on the strength of the supporting evidence (High ⊕⊕⊕⊕—Moderate ⊕⊕⊕ ⃝—Low ⊕⊕ ⃝ ⃝—Very low ⊕ ⃝ ⃝ ⃝). In the absence of evidence, the GDG formulated no recommendation or a good practice point (GPP) based on clinical expertise (
The guideline draft and an invitation to participate in the stakeholder review were published on the ESHRE website. In addition, all relevant stakeholders received a personal invitation to review by e-mail. We received 168 comments from 39 reviewers, representing 21 countries, two national societies (British Fertility Society and working groups from ESHRE). All comments were processed by the GDG, either by adapting the content of the guideline and/or by replying to the reviewer. The review process was summarized in the review report, which is published on the ESHRE website (
This guideline will be considered for update 4 years after publication, with an intermediate assessment of the need for updating 2 years after publication.
