Risk factors for ovarian hyperstimulation syndrome: Relevance of the number of follicles, serum estradiol levels and the number of oocytes collected

摘要

We read with interest Dr Bodri's editorial on our recent report 'Severe early ovarian hyperstimulation syndrome (OHSS) following GnRH agonist trigger with the addition of 1500 IU hCG' (Bodri, 2013; Seyhan et a/., 2013). However, we did question some of his comments.While Dr Bodri describes all other studies evaluating OHSS risks using this protocol as containing 'normo-responders' or just 'high responders' he calls our patients 'very high responders' and 'not suitable candidates for the Humaidan protocol (Bodri, 2013). Dr Bodri's opinion seems to be solely based on our collecting a higher number of oocytes compared with the study of Humaidan (2009). Although the number of oocytes collected is a well-known risk factor for OHSS, there are other risk indicators including serum estradiol levels and the number of growingfollicles (Papanikolaou et a/., 2006). While serum estradiol levels are determined using standardized techniques around the world, and even physicians and technicians with limited experience can count follicles, the number of oocytes collected depends on the experience of both the physician and the embryologist. Experience in aspiration of small follicles and in identifying oocytes surrounded with sparse cumulus cells is especially important for oocyte collection from women with polycystic ovaries, which contains numerous small follicles besides larger ones. We think the number of collected oocytes is more likely to vary between clinics and is a less reliable indicator of ovarian response than serum estradiol levels or the number of growingfollicles in this context.