Total antral follicle count by three-dimensional inversion mode ultrasonography reduce the risk of ovarian hyperstimulation syndrome in borderline PCOS women

The following review aims to examine the available evidence to guide best practice in preventing ovarian hyperstimulation syndrome (OHSS). As it stands, there is no single method to completely prevent OHSS. There seems to be a benefit, however, in categorizing women based on their risk of OHSS and individualizing treatments to curtail their chances of developing the syndrome. At present, both Anti-Müllerian Hormone and the antral follicle count seem to be promising in this regard. Both available and upcoming therapies are also reviewed to give a broad perspective to clinicians with regard to management options. At present, we recommend the use of a “step-up” regimen for ovulation induction, adjunct metformin utilization, utilizing a GnRH agonist as an ovulation trigger, and cabergoline usage. A summary of recommendations is also made available for ease of clinical application. In addition, areas for potential research are also identified where relevant.

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Antral follicle count and anti-Müllerian hormone level as predictors of ovarian hyperstimulation syndrome in women with polycystic ovarian syndrome undergoing controlled ovarian stimulation

Journal of Ultrasonography ◽

10.15557/jou.2021.0032 ◽

2021 ◽

Vol 21 (86) ◽

pp. e200-e205

Author(s):

Rubina Izhar ◽

◽

Samia Husain ◽

Muhammad Ahmad Tahir ◽

Mauzma Kausar ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Ovarian Stimulation ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovarian Syndrome ◽

Hormone Level ◽

Antral Follicle ◽

Antral Follicle Count ◽

Controlled Ovarian Stimulation ◽

Ovarian Hyperstimulation ◽

Ovarian Syndrome

Aim: To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. Methods: This was a prospective cohort study conducted in women aged 20–35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Results: Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls (p <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, p = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Conclusion: Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.

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Prediction of severe ovarian hyperstimulation syndrome in women undergoing in vitro fertilization using estradiol levels, collected ova, and number of follicles

Journal of International Medical Research ◽

10.1177/0300060520945551 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094555

Author(s):

Ivan Madrazo ◽

Monserrat Fabiola Vélez ◽

Josue Jonathan Hidalgo ◽

Ginna Ortiz ◽

Juan José Suárez ◽

...

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Characteristic Curve ◽

Antral Follicle ◽

Antral Follicle Count ◽

Ovarian Hyperstimulation ◽

Vitro Fertilization ◽

American Society ◽

Severe Ovarian Hyperstimulation Syndrome ◽

Severe Ohss

Objective Our objective was to determine whether estradiol (E2) levels (Day 3 and fold change to Day 10), antral follicle count (AFC), and number of ova collected could predict ovarian hyperstimulation syndrome (OHSS) and culdocentesis intervention. Methods We conducted a retrospective review of patient charts between January 2008 and December 2017. OHSS was defined using American Society for Reproductive Medicine criteria. Predictability was evaluated by measuring the area under the receiver operating characteristic curve (AUC). Results The cohort included 319 women (166 controls, 153 OHSS, of whom 54 had severe OHSS). The OHSS group had higher E2Day 3 (249 ± 177 vs. 150 ± 230 ng/L), E2FoldChange (32.2 ± 29.1 vs. 20.1 ± 23.8), AFC (18.2 ± 9.1 vs. 11.6 ± 8.3), and number of ova collected (21.1 ± 9.0 vs. 10.1 ± 6.5). E2Day 3 (AUC = 0.76, 95%CI: 0.71–0.82), E2FoldChange (AUC = 0.71, 95%CI: 0.65–0.77), AFC (AUC = 0.75, 95%CI: 0.70–0.81), and number of ova collected (AUC = 0.85, 95%CI: 0.81–0.89) were predictive for OHSS. All variables were predictive for culdocentesis intervention (E2Day 3: AUC = 0.63, 95%CI: 0.55–0.70; E2FoldChange: AUC = 0.63, 95%CI: 0.55–0.71; AFC: AUC = 0.74, 95%CI: 0.68–0.80; number of ova collected: AUC = 0.80, 95%CI: 0.75–0.85). Conclusions Day 3 E2 levels and number of ova collected predict patients who could develop OHSS and may require culdocentesis.

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Predictive Value of the AMH Level and Serum Estradiol for Ovarian Hyperstimulation Syndrome in the Assisted Human Reproduction

Revista de Chimie ◽

10.37358/rc.17.7.5735 ◽

2017 ◽

Vol 68 (7) ◽

pp. 1644-1647

Author(s):

Irina Pacu ◽

Cringu Ionescu ◽

Simona Vladareanu ◽

Mihai Banacu ◽

Adrian Neacsu ◽

...

Keyword(s):

High Risk ◽

Predictive Value ◽

Ovarian Hyperstimulation Syndrome ◽

Antral Follicle ◽

Antral Follicle Count ◽

Estradiol Level ◽

Human Reproduction ◽

Ovarian Hyperstimulation ◽

Assisted Human Reproduction ◽

Plasma Estradiol

The ovarian hyperstimulation syndrome (OHSS) is one of the major complications which occurs as a result of controlled ovarian stimulation (COS) in the assisted human reproduction. There are several factors including age, body mass index (BMI), plasma estradiol level, the anti-mullerian hormone (AMH) level and the antral follicle count (AFC), which can be used to identify the cases with high risk for this complication. The purpose of the study is to establish the predictive value of AMH for the development of OHSS before COS as well as its association with the plasma estradiol level during stimulation. The study group included 155 COS cycles using gonadotropin-releasing hormone (GnRH) agonist protocols, and analyzed the predictive value of the mentioned parameters for OHSS. The serum AMH level is superior to age and BMI for identification of patients with high risk for OHSS before starting the ovulation stimulation, and the cut-off level is 3.78ng/mlLwith 91.1% sensibility and 85.2% specificity.

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Predictive Value of the AMH Level and Serum Estradiol for Ovarian Hyperstimulation Syndrome in the Assisted Human Reproduction

Revista de Chimie ◽

10.37358/rc.17.5.5623 ◽

2017 ◽

Vol 68 (5) ◽

pp. 1114-1117

Author(s):

Irina Pacu ◽

Cringu Ionescu ◽

Simona Vladareanu ◽

Mihai Banacu ◽

Adrian Neacsu ◽

...

Keyword(s):

High Risk ◽

Predictive Value ◽

Ovarian Hyperstimulation Syndrome ◽

Antral Follicle ◽

Antral Follicle Count ◽

Estradiol Level ◽

Human Reproduction ◽

Ovarian Hyperstimulation ◽

Assisted Human Reproduction ◽

Plasma Estradiol

The ovarian hyperstimulation syndrome (OHSS) is one of the major complications which occurs as a result of controlled ovarian stimulation (COS) in the assisted human reproduction. There are several factors including age, body mass index (BMI), plasma estradiol level, the anti-mullerian hormone (AMH) level and the antral follicle count (AFC), which can be used to identify the cases with high risk for this complication. The purpose of the study is to establish the predictive value of AMH for the development of OHSS before COS as well as its association with the plasma estradiol level during stimulation. The study group included 155 COS cycles using gonadotropin-releasing hormone (GnRH) agonist protocols, and analyzed the predictive value of the mentioned parameters for OHSS. The serum AMH level is superior to age and BMI for identification of patients with high risk for OHSS before starting the ovulation stimulation, and the cut-off level is 3.78ng/mL with 91.1% sensibility and 85.2% specificity.

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