A Cross-sectional Study Of Ovarian Hyperstimulation Syndrome In Patients Having Polycystic Ovary Syndrome And Undergoing IVF/ICSI

Objective（s）:The purpose of this study is to understand the prevalence and distribution of ovarian hyperstimulation syndrome（OHSS）in patients having polycystic ovary syndrome（PCOS）and undergoing in vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）,to explore suspected factors affecting OHSS outcomes in this population,and to identify the high-risk group by combining the cut-off values of predicting the occurrence of OHSS.This study will provide a theoretical reference of preparing a better treatment plan for PCOS patients with infertility,achieving a better treatment outcome and reducing the prevalence of OHSS.Methods:This study was a cross-sectional study and selected patients by cluster sampling.Patients had PCOS and were treated with IVF/ICSI in the Department of Reproductive Genetics of the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2021.After the informed consent was obtained,this study was conducted using a questionnaire.The questionnaire included basic information,historical therapy,ovulation induction and the number of oocytes.Epidata 3.1 was used to establish a database for data double-entry and consistency test.10%of the total volume of questionnaire information were sampled for repeated surveys.SPSS 20.0 was used to perform statistical analysis of the data.After we compared the differences in OHSS prevalence among different PCOS populations and did univariate analysis by using chi-square test,unconditional binary logistic regression was performed to explore suspected factors affecting OHSS outcomes,and the ROC curve was further used to determine the cut-off values of each influencing factor to predict the occurrence of OHSS.Results1.The prevalence of OHSSFrom January 2016 to December 2021,131 of 1126 patients with PCOS attending the First Affiliated Hospital of Kunming Medical University had OHSS,with a prevalence of 11.6%.There was a difference in OHSS prevalence during the six-year period（χ²=48.197,P<0.001）.There was a decreasing trend in the prevalence of OHSS since 2018.2.Univariate analysis of factors affecting the prevalence of OHSSThe analysis of previous treatment in PCOS patients concluded that patients who had not been previously treated for PCOS were more likely to have OHSS（χ²=16.544,P<0.001）.The analysis of indicators before the start of ovulation induction in PCOS patients concluded that patients with high anti-mullerian hormone（AMH）levels were more likely to have OHSS（χ²=6.703,P=0.010）.In the basal sex hormone tests,patients with low basal follicle stimulating hormone（FSH）level had higher OHSS prevalence（χ²=7.215,P=0.007）,and patients with high testosterone（T）level had higher OHSS prevalence（χ²=4.284,P=0.038）.In the comparison of treating regimens of ovulation induction,the prevalence of OHSS differed between patients with or without the Gn RH-A regimen and the prolonged regimen.The prevalence of OHSS is lower in patients using Gn RH-A regimen（χ²=3.976,P=0.046）,but patients who used prolonged regimen had higher prevalence of OHSS（χ²=4.053,P=0.044）.The prevalence of OHSS was higher in those who used less dosage and duration of gonadotropin（Gn）in ovulation induction（P<0.05）,and there was a correlation between the two（r=0.379,P<0.05）.（1）After the ovulation inductionThe results of sex hormone test on the day of human chorionic gonadotropin administration（HCG trigger day）showed that the group with lower levels of FSH on HCG trigger day,the group with higher levels of estradiol（E₂）on HCG trigger day and the group with higher levels of progesterone（P）on HCG trigger day all had a higher prevalence of OHSS（P<0.05）.Those with higher number of follicle on HCG trigger day,receiving oocyte,mature oocyte,fertilization and normal fertilization were more likely to develop OHSS（P<0.001）.3.Logistic regression analysisVariables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression analysis in this study.The results revealed that PCOS treatment,E₂level on HCG trigger day,the number of oocyte on HCG trigger day,the number of mature oocyte and the number of fertilization were factors influencing the prevalence of OHSS in the PCOS population.The regression equation is logit（π）=-6.471+1.253X₁+1.316X₁₀+1.185X₁₂+0.973X₁₄+1.778X₁₅.And X₁means not receiving PCOS treatment,X₁₀means E₂level≥3500 pg/m L on HCG trigger day,X₁₂means the number of oocyte≥18 on HCG trigger day,X₁₄means the number of mature oocyte≥14,and X₁₅means the number of fertilization≥13.4.Analysis of clinical indicators to predict the outcome of OHSSWith reference to clinical expertise and the results of multifactorial analysis of this study,a total of six variables,namely E₂level on HCG trigger day,the number of oocyte on HCG trigger day,the number of receiving oocyte,the number of mature oocyte,the number of fertilization,and the number of normal fertilization,were selected for ROC curve analysis.The number of receiving oocyte,the number of oocyte on HCG trigger day,the number of fertilization,the number of normal fertilization and E₂level on HCG trigger day were consider to have predictive value for OHSS outcome,with the AUC being 0.789,0.755,0.741,0.736 and 0.727,and the cut-off values corresponding to the maximum values of the Jorden index were 18.5,18.5,14.5,11.5 and 4725 pg/m L.Conclusion（s）1.In this study,the prevalence of OHSS in patients having PCOS and undergoing IVF/ICSI is lower compared with similar studies and higher compared to other infertility populations.The prevalence showed a decreasing trend year by year since 2018.2.PCOS treatment,E₂level on HCG trigger day,the number of oocyte on HCG trigger day,the number of mature oocyte and the number of fertilization are factors influencing the prevalence of OHSS in the PCOS population.Based on the results of this study,it is concluded that not receiving PCOS treatment,excessive E₂level on HCG trigger day,excessive number of oocytes on HCG trigger day,excessive number of mature oocytes,and excessive number of fertilizations are risk factors for the prevalence of OHSS in patients having PCOS and undergoing IVF/ICSI.3.Combining the results of multifactorial analysis with clinical expertise of this study,clinical indicators that may influence the prevalence of OHSS are selected to understand their predictive value using ROC curves.And the results of ROC curve shows that the risk of developing OHSS increases when the number of receiving oocyte reaches 18.5,the number of oocyte on HCG trigger day reaches 18.5,the number of fertilization reaches 14.5,the number of normal fertilization reaches 11.5or E₂levels on HCG trigger day reaches 4725 pg/m L,which requires focused attention and prompt action.