Analysis of risk factors and prediction for ovarian hyperstimulation syndrome in patients with long-acting follicular phase in in vitro fertilization/intracytoplasm sperm injection

Objective To explore the risk factors associated with ovarian hyperstimulation syndrome (OHSS) in patients with long-acting long-term follicular phase in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and to establish Nomogram prediction model of OHSS. Methods A retrospective analysis of the clinical data of 6288 patients who underwent IVF/ICSI treatment in the Reproductive Center of the First Affiliated Hospital of Zhengzhou University from January 1, 2016 to September 30, 2017 was performed and these patients were randomly divided into two groups according to 4∶1, including 5044 cases in modeling group and 1244 cases in validation group. Logistic regression was used to screen out the independent risk factors affecting the occurrence of OHSS, which was the model enrollment variable, and the nomogram model was established according to the regression coefficient of the relevant variables. The prediction accuracy of the OHSS nomogram model was evaluated by calculating the area under the receiver operating characteristic (ROC) standard curve (AUC). Results Multivariate logistic regression analysis of the model group showed age, infertility type, body mass index (BMI), anti-Mullerian hormone (AMH), antral follicle number (AFC), and estrogen levels on human chronic gonadotropin hormone (hCG) injection day and the number of follicles > 10 mm in diameter were independent risk factors affecting the occurrence of OHSS. Based on the above factors, a predictive model for the risk of OHSS was constructed. The AUC of the model group was 0.842 (95% CI=0.829-0.856), and the AUC of the validation group was 0.798 (95% CI=0.767-0.830). Conclusion To screen out the risk factors of OHSS in patients with IVF/ICSI treatment, the successful establishment of nomogram model can effectively and easily predict the occurrence of OHSS. This study has certain clinical guiding significance for early prevention and treatment of OHSS. Key words: Fertilization in vitro; Intracytoplasmic sperm injection; Follicular phase long-acting gonadotropin-releasing hormone agonist long protocol; Ovarian hyperstimulation syndrome