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In Vitro Fertilization01:24

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The HERA (Hyper-response Risk Assessment) Delphi consensus definition of hyper-responders for in-vitro fertilization.

Ido Feferkorn1, B Ata2,3, S C Esteves4,5,6

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Journal of Assisted Reproduction and Genetics
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A hyper-response during ovarian stimulation is defined by collecting 15 or more oocytes. Key risk factors include antral follicle count and AMH levels, crucial for personalized IVF treatment.

Keywords:
Hyper-responseOvarian hyperstimulationOvarian stimulation

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Area of Science:

  • Reproductive Endocrinology
  • Assisted Reproductive Technology

Background:

  • Ovarian stimulation (OS) is a critical component of assisted reproductive technology (ART).
  • Defining hyper-response in OS is essential for optimizing treatment protocols and patient outcomes.
  • Current definitions lack standardization, leading to variability in research and clinical practice.

Purpose of the Study:

  • To establish a consensus-based definition of hyper-response in women undergoing ovarian stimulation.
  • To identify key risk factors associated with hyper-response during OS for ART.

Main Methods:

  • A comprehensive literature search was conducted on hyper-response in OS for ART.
  • A Delphi consensus method involving 31 experts was employed.
  • Consensus was defined as agreement among ≥66% of participants over a maximum of three rounds.

Main Results:

  • Consensus was reached on 17 out of 18 statements.
  • Hyper-response is defined by the collection of ≥15 oocytes, irrespective of OHSS development.
  • Key predictors for hyper-response include follicle count (≥10 mm), Anti-Müllerian Hormone (AMH) levels (≥2 ng/mL), and Antral Follicle Count (AFC) (≥18).
  • Polycystic Ovary Syndrome (PCOS) increases hyper-response risk.
  • In cases of discordant AMH and AFC, AFC is the more reliable predictor for hyper-response in first-time stimulation.

Conclusions:

  • The established definition of hyper-response and identified risk factors provide a standardized framework.
  • This consensus aids in harmonizing research, enhancing understanding, and personalizing patient care in ART.
  • Further research may refine the definition based on specific follicle counts.