Ovarian hyperstimulation syndrome: severity predictors

To evaluate clinical and laboratory parameters associated with the severity of ovarian hyperstimulation syndrome (OHSS) and to assess pregnancy outcomes in women hospitalized with moderate or severe OHSS. Several risk factors, including elevated antral follicle count (AFC), anti-Mullerian hormone (AMH), and serum estradiol (E2) levels, increase the risk of OHSS.

We studied 71 women with a median age of 32.7 years and a body mass index (BMI) of 22.8 kg/m2 with moderate (n=38) and severe (n=31) OHSS. We measured E2, hemoglobin (Hb), hematocrit (Hct), creatinine, albumin (Alb), total protein (TP), D-dimer (DD), and alanine aminotransferase (ALT) levels on the day of hospitalization and every second day until discharge. Data on the length of hospitalization, along with pregnancy outcomes, were recorded.

There were no intergroup differences between women with moderate and severe OHSS in terms of age and BMI. The total pregnancy rate in both moderate (18/38) and severe (9/31) OHSS was 27/69; however, in women with severe OHSS, the positive pregnancy outcome was approximately half that observed in the moderate OHSS group and was accompanied by longer hospitalization (2.9-fold). All women with OHSS had elevated initial E2 levels (>6910pg/mL). Women with severe OHSS had higher initial E2 (p=0.001) and Hct (p=0.006) levels, together with lower Alb and TP concentrations (both p<0.001), compared with those with moderate OHSS.

Elevated estradiol concentration is an associated factor for OHSS in women undergoing COH. Basal serum albumin concentration, together with total protein level and hematocrit, are predictive factors for OHSS severity.