Risk factors for OHSS

Risk factors present at baseline: Before gonadotropin administration

Previous OHSS

PCOS

Potential markers:

Basal serum anti-müllerian hormone >3.3 ng/mL

Antral follicle count >8

Single nucleotide polymorphisms (SNPs) in genes involved in follicular growth (BMP15)

Risk factors related to ovarian response

Multiple follicles >20 follicles larger than 10 mm

High or rapidly rising serum estradiol concentration (>3500 pg/mL [12,850 pmol/L] in COH)

High number of oocytes retrieved

hCG given for luteal phase supplementation

Elevated serum/follicular fluid VEGF levels

Pregnancy (increase in endogenous hCG)

OHSS: ovarian hyperstimulation syndrome; PCOS: polycystic ovary syndrome; BMP: bone morphogenetic protein; COH: controlled ovarian hyperstimulation; hCG: human chorionic gonadotropin; VEGF: vascular endothelial growth factor.

Adapted from: Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): The need for individualized not standardized treatment. Reprod Biol Endocrinol 2012; 10:32.

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Risk factors for OHSS