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

Abstract

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 E2_{Day 3} (249 ± 177 vs. 150 ± 230 ng/L), E2_FoldChange (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). E2_{Day 3} (AUC = 0.76, 95%CI: 0.71-0.82), E2_FoldChange (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 (E2_{Day 3}: AUC = 0.63, 95%CI: 0.55-0.70; E2_FoldChange: 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.

Keywords: Culdocentesis; antral follicle count; assisted reproduction; estradiol; in vitro fertilization; ovarian hyperstimulation syndrome.