Determinants of Severe Late Ovarian Hyperstimulation Syndrome in Fresh Embryo Transfer Cycles Based on Integration of Decision Tree Classification and Conditional Logistic Regression

Lijun Lin^1,†, Xuelian Yuan^2,3,†, Xiaohong Li^2,4, Sarah Hunt⁵, Ge Chen¹, Shan Luo^1,*, Xiaohong Li^1,*

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¹ Center for Reproductive Medicine, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

² National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

³ Key Laboratory of Birth Defects and Related Diseases of Women and Children of Sichuan University, Ministry of Education, 610041 Chengdu, Sichuan, China

⁴ Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

⁵ Department of Obstetrics and Gynecology, Monash University, 3168 Clayton, Australia

^*Correspondence: luoshan@scu.edu.cn (Shan Luo); lixiaohongham_001@163.com (Xiaohong Li)
^†These authors contributed equally.

Clin. Exp. Obstet. Gynecol. 2023, 50(2), 36; https://doi.org/10.31083/j.ceog5002036

Submitted: 28 October 2022 | Revised: 15 December 2022 | Accepted: 16 December 2022 | Published: 1 February 2023

This is an open access article under the CC BY 4.0 license.

Abstract

Background: To explore possible predictors of severe late ovarian hyperstimulation syndrome (SL-OHSS) in fresh embryo transfer cycles. Methods: We conducted a historical cohort study in a Chinese tertiary hospital from January 2017 to December 2019, with a total of 6931 women who had the first fresh embryo transfer included. SL-OHSS was defined as severe symptoms of OHSS occurring 12–17 days after ovulation triggering. Possible determinants of the occurrence of SL-OHSS were identified by a detection decision tree, effects of which were estimated by conditional logistic regression and restricted cubic spline. Results: Elevated estradiol (E2) on the day of ovulation triggering and elevated Anti-Mullerian hormone (AMH) were associated with an increased risk of SL-OHSS (p $<$ 0.001). Women with an E2 on trigger day of $\geq$ 3320.2 pg/mL (odds ratio (OR): 2.20; 95% confidence interval (CI): 1.03–4.68), or with an E2 on trigger day of $<$ 3320.2 pg/mL and an AMH of $\geq$ 4.62 ng/mL (OR: 5.44; 95% CI: 2.29–12.90), had an increased risk of SL-OHSS compared to their counterparts. Women with E2 on trigger day of $>$ 3320.2 pg/mL and AMH of $>$ 4.62 ng/mL had the highest risk of SL-OHSS (OR: 13.20; 95% CI: 3.87–45.02) when compared with E2 on trigger day of $\leq$ 3320.2 pg/mL and AMH of $\leq$ 4.62 ng/mL. This association was not linear. Conclusions: Serum E2 concentration on trigger day and AMH levels at baseline may predict SL-OHSS occurrence in fresh embryo transfer cycles. These biomarkers may be valuable in determining the optimum transfer strategy to limit the occurrence of SL-OHSS.

Keywords

ovarian hyperstimulation syndrome

fresh embryo transfer

estradiol

Anti-Mullerian hormone

decision tree model

Funding

2021YFS0243/Key R & D projects of Sichuan Provincial Department of Science and Technology

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Clin. Exp. Obstet. Gynecol. Print ISSN 0390-6663 Electronic ISSN 2709-0094