The Prediction Model Of Abdominal Water Volume In Patients With Ovarian Hyperstimulation Syndrome And Early Intervention Measures

Objective:A retrospective study clinical data of ovarian hyperstimulation syndrome(OHSS)was carried out.By establishing the regression equation,the risk factors related to the disease were analyzed.To establish and validate ascites volume forecast model by ultrasound.And the clinical effects of early intervention measures which based on transvaginal puncture and release ascites was analyzed retrospectively.Methods:1.139 cases of patients with moderate or severe OHSS were retrospectively collected from January 1,2017 to July 31,2017 in the reproductive medicine center of Nanjing Drum Tower Hospital were selected as the study group.And 160 cases of patients at the same time with no moderate or severe OHSS were randomly selected as the control group.Logistic regression and ROC analysis were used to analyze the related factors of OHSS occurrence.3489 cycles from August 1st 2017 to April 30th 2018,which received of IVF-ET and its derivative technology were se-lected in our center to evaluate the formula.2.Fifty patients(measurement group)received ultrasonographic measurement and then underwent ascites puncture drainage operations in 6 h.Three scatter diagrams of actual ascites volume(y;mL)and key positions ascites depth summation(x;mm),height correlation coefficient,surface area correlation coefficient was drawn.Regression equation which correlation was better,simpler and more practical,was be used as equation to be verified.Subsequently 100 OHSS patients as a verification group was enrolled.Forecast ascites volume calculated by above-mentioned regression equation,and consistency forecast and actual actual ascites volume were analyzed by Bland-Altman method and paired t test.3.The clinical data of 1190 cycles of moderate and severe OHSS from July 1,2007 to Dec 31,2017 in the reproductive medicine center of Nanjing Drum Tower Hospital were analyzed retrospectively.Taking the time of carrying out the comprehensive treatment technology of OHSS based on transvaginal puncture and ascites as the node,706 cycles of diagnosed moderate and severe OHSS during Jan 1,2012 to December 31,2016 were taken as the study group,and the remaining 484 cycles were taken as the control group.The general data and clinical outcomes of the two groups were compared.Result:1.The difference between the group with moderate and severe OHSS and the group without moderate and severe OHSS in Gn dosage and number of diameter more than 14mm follicles on trigger day were statistically significant(P<0.05),and the Logistic regression equation was as follows:P=1/(l+e(-z)),Z=-0.001x(Gn total amount)+0.097x(number of diameter more than 14mm follicles on trigger day)+0.058.Through ROC curve analysis,it was confirmed that Gn dosage and number of diameter more than 14mm follicles on trigger day did have predictive effect(P<0.05),the cut off value was 1781.25IU and 11.5,and the area under the cutoff value was 0.647 and 0.658,respectively.The 3489 cycles was included in the prediction formula for calculation.The sensitivity to predict the occurrence of moderate and severe OHSS was 56.25%(63/(63+49)),and the specificity was 98.19%(61/(61+3316)).2.Regression equation y=-256.554+10.452x(r2=0.577),which correlation was better,simpler and more practical,was obtained by the scatter diagram,then simplify was y=10.5x-250.0.The limits of consistency between forecast ascites volume and actual ascites volume was(-1 314.02,1 560.48)mL,bias was 123.23 mL;the difference between forecast ascites volume and actual ascites volume was not statistically significant(t=-1.684,P=0.096).3.Compared with the control group,the general data of the study group showed that there were no statistically significant differences between the two groups in age,BMI,infertility years,basal FSH value,basal E2 value,number of antral follicles,E2 value at the day of HCG injection,number of more than 14mm follicles on trigger day,natural abortion rate,live birth rate and average length of stay(P>0.05).In the study group,the basal LH value,the number of retrieved oocytes,and the preg-nancy rate were all higher than those in the control group,with statistically significant differences(P<0.001).Gn dosage in the study group,the incidence of moderate and severe OHSS,fresh cycle embryo transfer rate and hospitalization rate were all lower than the control group,and the difference was statistically significant(P<0.001).The average hospitalization fee of the study group was significantly higher than that of the control group,and the difference was statistically significant(P=0.025).Conclusions:The incidence of OHSS was higher in young patients with high num-ber of antral follicles,low basal FSH level,high basal LH level,high ratio of basal LH to FSH,low Gn dosage in IVF cycle,high E2 level on trigger day,number of diameter more than 14mm follicles on trigger day,and more retrieved oocytes.The Gn dosage in IVF cycle and the number of diameter more than 14mm follicles on trigger day can be used to establish the prediction model,while the cut off value is 1781.25IU and 11.5,but with low accuracy.Therefore,once the occurrence of moderate or severe OHSS occurs,early intervention measures should be taken to improve the patient’s symptoms and alleviate the patient’s pain.The simplified equation is y=10.5x-250.0 to forecast ascites volume caused by OHSS,which can guide the clinical work.According to the prediction formula for the occurrence of moderate and severe OHSS,combined with the general situation,symptoms,signs and other conditions of the patients,clinical determine whether it is necessary to cancel periodic then take whole embryo freezing and conduct comprehensive treatment such as capacity enlargement.The ascites volume prediction model can predict the total ascites volume of OHSS patients more accurately,and effectively assist the clinical judgment of whether the ascites should be released through vaginal puncture.The incidence of severe OHSS in our center decreased significantly with the improvement of OHSS preventive measures.The clinical use of the combined treatment of OHSS based on vaginal puncture and ascites significantly reduced the hospitalization rate of moderate and severe OHSS,significantly increased the clinical pregnancy rate,decreased the rate of fresh cycle embryo transfer,and no significant change in the average length of hospitalization.This treatment method saves a lot of medical resources.