Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI

Abstract

IntroductionAge, polycystic ovary syndrome (PCOS), low body mass index (BMI), high antral follicle count (AFC), increased anti-Muller hormone (AMH) levels, and elevated serum estradiol (E2) concentrations are risk factors for ovarian hyperstimulation syndrome (OHSS). However, data on the relationship between risk factors and OHSS severity in patients with PCOS are rare.ObjectiveThis retrospective study examined the risk factors for OHSS and their effect on OHSS severity in patients with PCOS undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodThe records of 2,699 women were reviewed and included in this study. These women were diagnosed with PCOS during their first IVF/ICSI cycle between January 2010 and December 2017. We analyzed the association between each of the interrogated risk factors (including female age, BMI, AFC, basal serum E2, and the number of oocytes retrieved) and OHSS. The effects of each risk factor on OHSS severity were further explored. Logistic regression was performed as part of the above analysis.ResultsOf the 2,699 women with PCOS who underwent assisted reproductive technology (ART), 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% developed OHSS. All OHSS patients were younger and had lower BMIs and basal serum follicle-stimulating hormone (FSH) and E2 levels but higher AFCs than those in the normal group. AFC demonstrated a strong correlation with OHSS, with a cutoff value of 24 in patients with PCOS. A total of 19.5% of the patients had mild OHSS, while 80.5% had moderate OHSS. Compared with those in the moderate OHSS group, those in the mild OHSS group were older and had higher basal serum FSH levels and lower serum E2 and T levels. However, BMI and AFC were not different between the mild and moderate OHSS groups. Basal serum E2 showed a strong correlation with OHSS severity, with a cutoff value of 37.94 pg/ml.ConclusionsAFC is a strong marker of OHSS, and basal serum E2 is the best predictor of OHSS severity in women with PCOS undergoing IVF treatment.

Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

“…It has been estimated, among the females receiving IVF-ET in clinical, the prevalence of mild was approximately 20% to 33%, and the moderate or severe females was nearly 3% to 8% [ 5 ]. Females with a high ovarian response, such as ovulation disorders and polycystic ovary syndrome (PCOS), as well as young age and low body mass index, are associated with an increased risk of OHSS [ 6 ]. For decades, human chorionic gonadotropin (hCG), which induces luteinization of granulosa cells and triggers final oocyte maturation, has been widely used in COH.…”

Development and Validation of Prediction Model for High Ovarian Response in In Vitro Fertilization-Embryo Transfer: A Longitudinal Study

“…The reason may be that AMH concentration correlates significantly with the number of sinusoidal follicles in the ovary before ovulation and the number of oocytes collected after treatment, and patients with high ovarian response have higher AMH concentration compared with patients with normal ovarian response. Not only that, AMH was regarded as an excellent predictor of high ovarian response and could identify the risk of OHSS better than AFC, which may be due to the fact that AMH has more stable periodicity and is less susceptible to exogenous steroid hormones; moreover, AFC requires skilled ultrasound operators to carefully identify, measure, and count ovarian eggs, probably resulting in more interobserver variability in AFC [7,18,[21][22][23][24][25]. However, few studies have analyzed the association between P level on HCG day and high ovarian response.…”

Antimüllerian hormone use and misuse in current reproductive medicine practice: a clinically oriented review

“…For example, a secondary analysis of the Pregnancy in PCOS II trial found that higher baseline AMH level predicted poorer response to ovulation induction during treatment with oral medications (99). During in vitro fertilization, a higher AMH level has also been linked to an increased risk of OHSS in the setting of gonadotropin stimulation (100). The AMH level for a PCOS fertility patient may therefore enhance a clinician's ability to provide personalized decisions during the treatment course.…”