Abstract
ObjectiveTo investigate the effect of seasons on the incidence of high risk of ovarian hyperstimulation syndrome (OHSS) after in oocyte retrieval in patients with polycystic ovarian syndrome (PCOS) and to establish a nomogram to predict the risk of OHSS.DesignSingle-center, retrospective study.SettingUniversity-affiliated reproductive medicine center.Patient(s)A total of 2,030 infertility patients with PCOS underwent the follicular phase long-acting long protocol IVF/ICSI in the reproductive medicine center from January 2017 to December 2019.Intervention(s)None.Main outcome measure(s)Logistic regression analysis was used to analyze the factors associated with a high risk of OHSS. We established a nomogram to predict the risk of OHSS in infertility patients with PCOS after oocyte retrieval.Result(s)The incidence of patients at high risk of OHSS was significantly different from season-to-season and was especially higher in the summer and winter. Multivariate logistic analysis showed that gonadotropin dosage, number of retrieved oocytes, estradiol level, average bilateral ovarian diameter on the day human chorionic gonadotropin was administered, type of infertility, and average temperature were independent risk factors for OHSS after oocyte retrieval in PCOS patients. Based on the above independent risk factors, we constructed a prediction model for OHSS risk. To evaluate the efficiency of the prediction model, we calculated the C-index (0.849), area under the receiver operating characteristic curve (0.849), and internal validation C-index (0.846). Decision curve analysis suggested that the prediction model exhibited significant net benefits.Conclusion(s)The incidence of PCOS patients at high risk for OHSS after oocyte retrieval fluctuated with seasonal temperature changes, and was significantly higher in extreme climates. The prediction model had favorable predictive performance and clinical application value.
Highlights
Seasonal changes affect the development of many diseases and are closely related to the morbidity and mortality rate of hospitalization [1, 2]
The results indicated that the number of retrieved oocytes, average bilateral ovarian diameter on the day of HCG administration, Gn dosage, incidence of patients at high risk for Ovarian hyperstimulation syndrome (OHSS), and live birth rate were statistically different between seasons (P < 0.05; Table 1 and Figure 1)
Patients with polycystic ovary syndrome (PCOS) are at an increased risk for OHSS due to the high ovarian responsivity to gonadotropin stimulation [11]
Summary
Seasonal changes affect the development of many diseases and are closely related to the morbidity and mortality rate of hospitalization [1, 2]. Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian hyperstimulation (COH) that is related to age, body mass index, ovarian function, and the ovulation stimulation protocol. The risk of OHSS in polycystic ovary syndrome (PCOS) patients is significantly increased [5]. Emerging evidence has shown that OHSS is associated with inflammatory factors interleukin (IL)-6, tumor necrosis factor (TNF)-a, IL-8, vascular endothelial growth factor, and the local renin-angiotensin aldosterone system, which led to a series of pathologic changes, including increased capillary permeability, leakage of vascular fluid into the interstitial space to form pleural effusions or ascites, decreased effective circulating blood volume, blood concentration, and even thrombosis [6, 7]
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