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Ovarian hyperstimulation syndrome (OHSS) is still a severe complication due to controlled ovarian stimulation for artificial reproductive technology. Even though multiple techniques to avoid OHSS have been discussed in the last decades, up to now no clear concepts for primary and secondary prevention exist. This review gives an overview over proposed strategies to avoid OHSS. In a retrospective analysis of 370 cycles of controlled ovarian stimulation for ART at our Department of Gynecology and obstetrics we analyzed the risk of OHSS. An algorithm for choosing the starting dose of gonadotropins is presented, which is based on individual parameters as AMH, younger age, higher ovarian reserve for women with the diagnosis of polycystic ovarian syndrome.