Luteal phase support and severe ovarian hyperstimulation syndrome

Area of Science:

• Reproductive Endocrinology
• Infertility Treatments
• Clinical Obstetrics and Gynecology

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a significant risk in assisted reproductive technologies.
• Understanding OHSS predictors is crucial for patient safety and treatment optimization.
• The role of luteal phase support in OHSS development requires further clarification.

Purpose of the Study:

• To investigate the incidence and statistical associations of OHSS in women undergoing assisted reproduction.
• To identify key factors predicting the occurrence of moderate to severe OHSS.
• To compare the impact of different luteal phase support strategies on OHSS risk.

Main Methods:

• Retrospective analysis of 304 egg retrievals involving gonadotropin-releasing hormone agonist suppression, gonadotropin administration, and follicular aspiration.
• Statistical comparison of OHSS incidence between luteal phase human chorionic gonadotropin (HCG) and progesterone supplementation.
• Stepwise logistic regression analysis to identify predictors of moderate or severe OHSS, including serum estradiol, HCG use, and fetal number.

Main Results:

• Luteal phase HCG administration was associated with a significantly higher incidence of severe OHSS (12%) compared to progesterone alone (0%).
• Severe OHSS occurred more frequently in cycles with pregnancy (12%) than without (3.7%).
• Key predictors for moderate/severe OHSS included serum estradiol levels on HCG administration day, luteal phase HCG use, and fetal number.

Conclusions:

• Luteal phase HCG significantly elevates the risk of severe OHSS, particularly when compared to progesterone support.
• Elevated serum estradiol and the presence of pregnancy are critical factors contributing to OHSS development.
• Establishing estradiol upper limits for luteal phase HCG and non-HCG cycles can help mitigate OHSS risk.