Infertility is on the rise globally, and with it, the demand for assisted reproductive technologies (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). While these techniques offer hope to many couples, they are not without risks, particularly ovarian hyperstimulation syndrome (OHSS), which can lead to severe complications. A recent study from the Reproductive Medicine Department of the Second Affiliated Hospital of Zhengzhou University has shed light on the risk factors associated with moderate to severe OHSS and introduced a predictive nomogram model for clinicians.
The research analyzed clinical data from 4,204 patients undergoing IVF/ICSI between January 2015 and August 2024, all treated with the early-follicular phase long-acting gonadotropin-releasing hormone agonist long protocol (EFLL). Among these patients, 117 developed moderate to severe OHSS, presenting significant health risks such as fluid imbalance, abdominal discomfort, and, in severe cases, severe complications including renal failure and thrombosis.
Identifying women at risk of developing OHSS is pivotal. The study's findings revealed five independent risk factors: Antral follicle count (AFC), estrogen and progesterone levels at the time of human chorionic gonadotropin (hCG) injection, presence of hypothyroidism, and the type of infertility being treated. According to the authors of the article, AFC (OR, 1.04; 95%CI, 1.02 1.07; P = 0.002), estrogen levels on the day of hCG injection (OR, 1.01; 95%CI, 1.01 1.01; P<0.01), progesterone levels on the day of hCG injection (OR, 1.18; 95%CI, 1.04 1.34; P = 0.011), whether the patient had hypothyroidism (OR, 3.62; 95%CI, 2.106.23; P < 0.001), and infertility type (OR, 0.59; 95%CI, 0.35 0.99; P = 0.048) are the independent risk factors for the occurrence of moderate to severe OHSS across fresh cycles.</p>
The researchers used logistic regression analysis to establish the risk factors and then developed a nomogram—a visual representation showing individual patients' probabilities of developing OHSS based on their specific clinical profiles. The accuracy of the nomogram was confirmed using Receiver Operating Characteristic curves, yielding areas under the curve (AUC) of 0.83 for the modeling group and 0.84 for the validation group, indicating reliable performance.
The study is timely as the incidence of moderate to severe OHSS is of increasing concern parallel to the rise of ART, which accounts for over one million cycles annually across China alone. The incidence of moderate to severe OHSS has been reported to be around 1.14%, as per prior investigations. The effects of OHSS can not only burden healthcare systems but also impose significant psychological and financial pressures on affected individuals. The authors argue for improved risk management approaches, emphasizing the importance of identifying and monitoring high-risk patients during the IVF process.
OHSS is classified based on clinical severity, from mild cases posing minimal risk to severe cases requiring hospitalization. Preventive strategies include careful monitoring of hormone levels and modifying stimulation protocols to safeguard vulnerable patients. The use of methods such as freezing embryos can reduce the risks associated with fresh transfers, but might also diminish success rates when not properly managed.
This research adds depth to existing knowledge surrounding HOOS and refines the focus on personalized patient care through advanced predictive modeling. By equipping reproductive endocrinologists with new predictive tools, the likelihood of OHSS can be minimized, enhancing patient safety and long-term treatment outcomes.
Nevertheless, this study is not without limitations. Retrospective data analysis implicates potential disparities inherent to patient baseline characteristics, and the sample size indicates the need for multicenter validation to generalize findings comprehensively. Further investigations are warranted to incorporate multifactorial predictive elements and clarify hindrances, enabling comprehensive risk mitigation strategies for patients undergoing ART.
Conclusively, the presence of elevated AFC, estrogen levels on the day of hCG, progesterone levels at trigger, hypothyroidism, and infertility type emerged as significant predictive factors for moderate to severe OHSS. Through the establishment of the nomogram model, this study lays groundwork for effectively forecasting OHSS incidence, offering clinical practitioners improved oversight over patient management during assisted reproduction.
