Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles
Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles
复制标题
DOI：
10.1016/j.fertnstert.2005.07.1292
复制
发表时间：
2006-01-01
影响因子：
6.7
通讯作者：
Devroey, P
中科院分区：
文献类型：
--
作者：
Papanikolaou, EG;Pozzobon, C;Devroey, P
目的：确定大系列GnRH拮抗剂刺激周期中卵巢过度刺激综合征（OHSS）的发生率，并评价给药当日E-2及卵泡数的预测价值。设计：对接受GnRH拮抗剂体外受精治疗的妇女进行为期2年的前瞻性队列研究。单位：第三大学附属医院。患者：接受2524个周期的1801例患者。干预措施：用重组FSH和GnRH拮抗剂刺激多卵泡卵巢用于IVF-ICSI治疗。主要结局指标：GnRH拮抗剂周期中OHSS的发生率、E-2的预测值、hCG发生当天的卵泡数。结果：53例患者因OHSS住院（2.1%；95%可信区间[CI]: 1.6-2.8）。31例患者出现早期OHSS (1.2%, 95% CI: 0.9-1.8)，而22例患者出现晚期OHSS并发症（0.9%,95% CI: 0.5-1.3）。晚期OHSS病例与早期OHSS病例相比总是发生在妊娠周期（100% vs 40%）；严重的可能性更高（72.7%对42%），并且更多地与多胎妊娠相关（40%对0）。对几种E-2浓度和直径为>= 11 mm的卵泡数的受试者工作特征曲线分析显示，>= 13个卵泡的最佳阈值（敏感性85.5%，特异性69%）的预测值在识别OHSS风险患者方面具有统计学意义上显著优于E-2浓度2560 ng/L的最佳阈值（敏感性53%，特异性77%）。考虑到重度OHSS是最具临床意义的模式，结合>= 18个卵泡和/或>= 5000 ng/L的E-2阈值，对重度OHSS病例的敏感性为83%，特异性高达84%。结论：即使使用GnRH拮抗剂方案，临床上显著的OHSS仍然是体外受精多卵泡卵巢刺激的一个限制。卵泡的数量可以区分有发展为OHSS风险的患者，而E-2浓度在预测目的上不太可靠。比以往任何时候都更迫切需要替代最终卵母细胞成熟触发药物。
Objective: To determine the incidence of ovarian hyperstimulation syndrome (OHSS) in a large series of GnRH antagonist-stimulated cycles and to assess the predictive value of E-2 and the number of follicles on the day of hCG administration.Design: Prospective cohort study of women undergoing IVF treatment with a GnRH antagonist protocol over a 2-year period.Setting: Tertiary university hospital.Patient(s): One thousand eight hundred one patients who underwent 2,524 cycles.Intervention(s): Multifollicular ovarian stimulation with recombinant FSH and GnRH antagonist for IVF-ICSI treatment.Main Outcome Measure(s): Incidence of OHSS in GnRH antagonist cycles, predictive value of E-2, and number of follicles on the day of hCG for OHSS occurrence.Result(s): Fifty-three patients were hospitalized because of OHSS (2.1%; 95% confidence interval [CI]: 1.6-2.8). Early OHSS presented in 31 patients (1.2%; 95% CI: 0.9-1.8), whereas the late type was a complication in 22 patients (0.9%; 95% CI: 0.5-1.3). Late OHSS cases compared with the early OHSS cases always occurred in a pregnancy cycle (100% vs. 40%); had higher probability of being severe (72.7% vs. 42%), and more often were related to a multiple pregnancy (40% vs. 0). Receiver operating characteristic curve analysis for several E-2 concentrations and number of follicles with a diameter of >= 11 mm revealed that the predictive value of the optimal threshold of >= 13 follicles (85.5% sensitivity; 69% specificity) was statistically significantly superior to the optimal threshold of 2,560 ng/L for E-2 concentrations (53% sensitivity, 77% specificity) in identifying patients at risk for OHSS. Considering that severe OHSS represents the most clinically significant pattern, the combination of a threshold of >= 18 follicles and/or E-2 of >= 5,000 ng/L yields a 83% sensitivity rate with a specificity as high as 84% for the severe OHSS cases.Conclusion(s): Clinically significant OHSS still remains a limitation of multifollicular ovarian stimulation for IVF even with the use of GnRH antagonist protocols. The number of follicles can discriminate the patients who are at risk for developing OHSS, whereas E-2 concentrations are less reliable for the purpose of prediction. There is more than ever an urgent need for alternative final oocyte maturation-triggering medication.