Prediction of patients with ovarian hyperstimulation syndrome in gonadotropin-releasing hormone agonist prolonged protocol: a retrospective study

Abstract

Background: Ovarian Hyperstimulation Syndrome (OHSS), a life-threatening complication and the most common adverse effect of fertility treatment, currently lacks an effective prevention method. Objectives: We investigated associated risk factors of OHSS in stimulated ovarian cycles with assisted reproductive technology (ART), with the aim of providing guidance for clinicians on how to prevent OHSS. Methods: A logistic regression analysis was conducted on 336 patients who had completed in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI)/embryo transfer (ET) cycles between April 2019 and April 2021 in the first affiliated hospital of Kunming Medical University. Receiver-operating characteristic (ROC) curves for OHSS were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers. Results: According to clinical diagnosis, 61 out of 336 cycles experienced OHSS, resulting in an incidence rate of 18.15%. Patients were graded based on their clinical symptoms and severity, with 27 instances of moderate OHSS (8.04%) and 8 cases of severe OHSS (2.38%). The cut-off values for anti-Müllerian hormone (AMH), Estradiol (E2) on Human Chorionic Gonadotropin (HCG) day, and eggs retrieved to predict moderate and severe OHSS were determined as 7.495 ng/ml, 4828 pg/ml, and 19.5, respectively, in the Gonadotropin-Releasing Hormone agonist (GnRH-a) Prolonged Protocol. The sensitivities for these parameters were 77.0%, 67.2%, and 80.3%, with specificities of 68.0%, 70.9%, and 81.5%, respectively. AUC values for AMH, E2 on HCG day, and the number of retrieved oocytes, predicting moderate and severe OHSS, were 0.754, 0.738, and 0.876, respectively. Additionally, the combined index yielded an AUC value of 0.898, attaining the highest AUC with 85.2% sensitivity and 83.6% specificity. Conclusions: AMH, E2 on the day of HCG administration, and the total number of retrieved eggs collectively exhibit a robust predictive influence on the occurrence of OHSS. The predictive efficacy is enhanced significantly when these three indicators are combined.