As infertility rates continue to rise globally, so does the demand for assisted reproductive technologies (ART) like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). While ART offers a beacon of hope for many, it also carries risks, including ovarian hyperstimulation syndrome (OHSS), a condition that can result in severe complications. A recent study conducted by the Reproductive Medicine Department of the Second Affiliated Hospital of Zhengzhou University has developed a predictive nomogram aimed at better identifying patients at risk for moderate to severe OHSS during assisted reproduction.
The study analyzed the clinical data of 4,204 patients undergoing IVF/ICSI from January 2015 to August 2024, all of whom were treated using the early-follicular phase long-acting gonadotropin-releasing hormone agonist long protocol (EFLL). Out of these patients, 117 developed moderate to severe OHSS, a condition characterized by symptoms ranging from fluid imbalance and abdominal discomfort to life-threatening issues such as renal failure and thrombosis.
Understanding the risk factors for OHSS is crucial for preventing the condition. The study identified five independent risk factors: Antral follicle count (AFC), estrogen and progesterone levels on the day of human chorionic gonadotropin (hCG) injection, the presence of hypothyroidism, and the type of infertility being treated. According to the study, AFC (OR, 1.04; 95%CI, 1.02-1.07; P = 0.002), estrogen levels (OR, 1.01; 95%CI, 1.01-1.01; P < 0.01), progesterone levels (OR, 1.18; 95%CI, 1.04-1.34; P = 0.011), hypothyroidism (OR, 3.62; 95%CI, 2.10-6.23; P < 0.001), and infertility type (OR, 0.59; 95%CI, 0.35-0.99; P = 0.048) are key indicators for moderate to severe OHSS.
To translate these findings into clinical practice, the researchers employed logistic regression analysis to create a nomogram—an easy-to-read chart that allows clinicians to estimate a patient’s individual risk for OHSS based on specific clinical factors. The accuracy of this predictive tool was validated using Receiver Operating Characteristic (ROC) curves, with the nomogram achieving an area under the curve (AUC) of 0.83 in the modeling group and 0.84 in the validation group, indicating its strong predictive performance.
The significance of this research is underscored by the growing incidence of OHSS, especially with ART becoming more widespread. In China alone, over one million ART cycles are performed annually, with moderate to severe OHSS occurring in approximately 1.14% of these cases. The impact of OHSS extends beyond physical health, placing considerable psychological and financial strain on patients and healthcare systems alike. The researchers argue that improving risk management and identifying high-risk patients early in the IVF process is crucial for mitigating OHSS.
OHSS varies in severity, from mild cases with minimal risk to severe cases that may require hospitalization. Preventive measures include closely monitoring hormone levels, adjusting stimulation protocols, and, in some cases, freezing embryos to reduce the risks associated with fresh embryo transfers. However, freezing embryos may also impact success rates, requiring careful management to balance safety and efficacy.
This study contributes valuable insights into OHSS and underscores the importance of personalized care in reproductive medicine. By providing reproductive endocrinologists with an effective tool to predict OHSS risk, the nomogram can help improve patient safety and optimize long-term treatment outcomes.
However, the study has limitations. As a retrospective analysis, it is subject to potential biases related to patient characteristics, and the sample size calls for further validation through multicenter trials to ensure the findings are broadly applicable. Future research should explore additional factors and refine the predictive model to enhance its effectiveness in clinical settings.
In conclusion, elevated AFC, estrogen and progesterone levels at hCG trigger, hypothyroidism, and infertility type have been identified as critical risk factors for moderate to severe OHSS. The newly developed nomogram offers a promising approach to predict OHSS risk, allowing clinicians to manage patient care more effectively during assisted reproduction cycles.
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