title: Prediction of Ovarian Hyperstimulation Syndrome in Patients Treated with Corifollitropin alfa or rFSH in a GnRH Antagonist Protocol.
abstract: OBJECTIVE
  What is the threshold for the prediction of moderate to severe or severe ovarian hyperstimulation syndrome (OHSS) based on the number of growing follicles ≥ 11 mm and/or estradiol (E2) levels?
  
  
  CONCLUSIONS
  The optimal threshold of follicles ≥11 mm on the day of hCG to identify those at risk was 19 for both moderate to severe OHSS and for severe OHSS. Estradiol (E2) levels were less prognostic of OHSS than the number of follicles ≥ 11 mm.
  
  
  BACKGROUND
  In comparison to long gonadotropin-releasing hormone (GnRH) agonist protocols, the risk of severe OHSS is reduced by approximately 50% in a GnRH antagonist protocol for ovarian stimulation prior to in vitro fertilisation (IVF), while the two protocols provide equal chances of pregnancy per initiated cycle. Nevertheless, moderate to severe OHSS may still occur in GnRH antagonist protocols if human chorionic gonadotropin (hCG) is administered to trigger final oocyte maturation, especially in high responder patients. Severe OHSS following hCG trigger may occur with an incidence of 1-2% in a relatively young (aged 18 to 36 years) IVF population treated in a GnRH-antagonist protocol.
  
  
  METHODS
  From the Engage, Ensure and Trust trials, in total, 2,433 women who received hCG for oocyte maturation and for whom the number of follicles ≥ 11 mm and the level of E2 on the day of hCG administration were known were included in the analyses.
  
  
  METHODS
  The threshold for OHSS prediction of moderate and severe OHSS was assessed in women treated with corifollitropin alfa or daily recombinant follicle stimulation hormone (rFSH) in a gonadotropin-releasing hormone (GnRH)-antagonist protocol. Receiver operating characteristics curve analyses for moderate to severe OHSS and severe OHSS were performed on the combined dataset and the sensitivity and specificity for the optimal threshold of number of follicles ≥ 11 mm, E2 levels on the day of (hCG), and a combination of both, were determined.
  
  
  RESULTS
  The optimal threshold of follicles ≥ 11 mm on the day of hCG to identify those at risk of moderate to severe OHSS was 19 (sensitivity and specificity 62.3% and 75.6%, respectively) and for severe OHSS was also 19 (sensitivity and specificity 74.3% and 75.3%, respectively). The positive and negative predictive values were 6.9% and 98.6%, respectively, for moderate to severe OHSS, and 4.2% and 99.5% for severe OHSS.
  
  
  CONCLUSIONS
  This was a retrospective analysis of combined data from three trials following ovarian stimulation with two different gonadotropins.
  
  
  CONCLUSIONS
  For patients with 19 follicles or more ≥11 mm on the day of hCG, measures to prevent the development of OHSS should be considered. Secondary preventive measures include cycle cancellation or coasting, use of a GnRH agonist to trigger final oocyte maturation in place of hCG and a freeze all strategy.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00702845 NCT00696800 NCT00696878.
authors.affiliation: Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
authors.affiliation: MSD BV, Oss, The Netherlands.
authors.forename: Pierre J M
authors.initials: PJ
authors.lastname: Verweij
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, United States of America.
authors.forename: Davis
authors.initials: D
authors.lastname: Gates
authors.affiliation: Center for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Devroey
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, United States of America.
authors.forename: Keith
authors.initials: K
authors.lastname: Gordon
authors.affiliation: Merck & Co., Inc., Kenilworth, NJ, United States of America.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stegmann
authors.affiliation: 1st Department of Obstetrics and Gynecology, Papageorgiou Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Basil C
authors.initials: BC
authors.lastname: Tarlatzis
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000009:adverse effects* / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D004958:Estradiol / Q000378:metabolism; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000009:adverse effects* / Q000494:pharmacology*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D009929:Organ Size / Q000187:drug effects; D006080:Ovarian Follicle / Q000187:drug effects / Q000254:growth & development; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced* / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D043373:Follicle Stimulating Hormone, Human; D006727:Hormone Antagonists; C437186:follicle stimulating hormone, human, with HCG C-terminal peptide; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol