Analysis Of The Influencing Factors Of Ovarian Hyperstimulation Syndrome

Objective: To understand the role of ovarian hyperstimulation in assisted reproductive technology(ART)in infertility.The distribution characteristics of OHSS in general conditions,ovulation induction treatment process and treatment outcome indicators;to explore the influencing factors of OHSS in ART process,and to elaborate the influence of OHSS on ART pregnancy outcome,so as to provide reference for clinical prevention of OHSS.Methods: A total of 348 patients who performed assisted reproductive technology in the reproductive center of Taiyuan Central Hospital from September 2017 to June 2019 were collected continuously,of which 164 OHSS patients were used as the case group,and the remaining 184 non-OHSS patients were used as the control group.Collect and organize the general situation of patients(age,BMI,type of infertility,basic sex hormones,coagulation function,thyroid function,etc.),and the treatment status of controlled ovarian hyperstimulatio(COH)(ART types,ovulation-promoting programs,the amount of Gn activation,the amount of Gn,E2 / LH / P on HCG day,etc.),and the outcome of COH treatment(observe the number of follicles on the day of egg retrieval,the number of eggs obtained,whether or not fresh embryo transplantation,pregnancy,etc.).At the same time,a case-control study method was used to analyze the relationship between different factors and the occurrence of OHSS and its different degrees(mild and moderate).Results:1.General situation of patients: The differences of age,height,weight,BMI,infertility years,basic LH,basic E2,PT,APTT,FT3,FT4,TSH,type of infertility,prolonged menstrual cycle and history of intrauterine cavity surgery in the case group and in the control group were not statistically significant(P>0.05),and the base FSH,basal follicle count,PCOS,and ART history were related to the occurrence of OHSS;Gn use time,total Gn,and HCG day P during ovulation promotion,Ln on the sixth day of Gn,LH on the fourth day of Gn,the amount of activation and the type of ART were not statistically significant between the two groups(P>0.05),while HCG day E2,HCG day LH,egg retrieval day E2,Gn day E2 on the sixth day,Gn on the fourth day,E2,the ovulation-promoting program,the type of ovulation-promoting drugs,and trigger medication are related to the occurrence of OHSS;ovulation-promoting treatment outcome indicators such as whether pelvic effusion is drawn on the day of oocyte retrieval,and the number of follicles on the ultrasound day and the total number of eggs obtained was related to the occurrence of OHSS.2.After adjusting patient age,PCOS,uterine cavity operation history,trigger medication,HCG day E2,HCG day LH,ovulation day E2,Gn sixth day E2,Gn fourth day E2,ovulation promotion program,ovulation promotion drug type,whether the uterine effusion was drawn on the day of egg retrieval,the number of follicles and the total number of eggs obtained by B-ultrasound on the day of egg retrieval,it was found that the simple Gn scheme(OR=0.101,95%CI: 0.019~0.606),the trigger medication HCG10000IU(OR = 0.069,95% CI: 0.006~0.844),E2 on HCG day <2000 pg / ml(OR=0.038,95% CI: 0.006~0.237),E2 on HCG day is 2000~2999 pg / ml(OR=0.016,95% CI: 0.002~0.111),E2 on HCG day is 3000~3999pg / ml(OR=0.163,95% CI: 0.048~0.559),E2 on HCG day is 4000~4999pg / ml(OR=0.106,95% CI: 0.027~0.424),E2?1000 pg / ml(OR=0.169,95% CI: 0.030~0.959)on the 6th day of Gn are protective factors for OHSS;PCOS(OR= 4.542,95% CI: 1.606~12.843)),a history of intra-abdominal operation(OR=3.995,95% CI: 1.413~11.295),E2 ? 300 pg / ml(OR=16.208,95% CI: 1.195~219.880),Gn on the 4th day 301~600pg / ml(OR=11.581,95% CI: 1.238~108.315)and other risk factors for OHSS;long plan(OR=0.175,95% CI: 0.050~2.420),antagonist protocol(OR=0.033,95% CI: 0.004~1.771),HCG daily observation of follicles 16-20(OR=1.172,95% CI: 0.775~ 1.771)were not found to be related to the occurrence of OHSS.3.After stratified analysis according to the degree of occurrence of OHSS,patients with mild OHSS received only Gn regimen(OR=0.100,95% CI: 0.015~0.690),long regimen(OR=0.132,95% CI: 0.033~0.536),and antagonist protocol(OR=0.033,95% CI: 0.033~0.395),trigger medicine HCG10000IU(OR=0.051,95% CI: 0.003 ~ 0.824),H2 day E2 <2000 pg / ml(OR=0.019,95% CI: 0.002~0.168),H2 day E2 is 2000~2999 pg / ml(OR=0.006,95% CI: 0.000~0.076),HCG day E2 is 3000~3999pg / ml(OR=0.141,95% CI: 0.037~0.2004),H2 day E2 is 4000~4999pg / ml(OR=0.079,95% CI: 0.018~0.351),Gn day 6 E2?1000 pg / ml(OR=0.135,95% CI: 0.021~0.888)all were protective factors for mild OHSS;PCOS(OR=8.752,95% CI: 2.632 ~ 29.104),intraperitoneal operation history(OR=6.155,95% CI: 1.986 ~ 19.076),E2 ? on the 4th day of Gn 300 pg / ml(OR=22.472,95% CI: 1.355 ~ 372.587),E2 on the 4th day of Gn is 301 ~ 600 pg / ml(OR=16.220,95% CI: 1.496 ~ 175.854),and the number of follicles observed on HCG day is 16 ~ 20(OR= 24.011,95% CI: 2.079 ~ 277.327)all were risk factors for mild OHSS.Patients with moderate OHSS who had effusions on the day of egg retrieval(OR=201.284,95% CI: 1.788 ~ 22653.369),basic FSH?5 m IU / ml(OR=0.002,95% CI: 0.000 ~ 0.595),Gn On the 6th day,E21301 ~ 1600 pg / ml(OR=324.394,95% CI: 1.799 ~ 58483.854)all were risk factors for the occurrence of moderate OHSS;the antagonist regimen(OR=0.000,95% CI: 0.000 ~ 0.715),obtained The number of eggs ?15(OR=0.000,95% CI: 0.000 ~ 0.692)are protective factors for the occurrence of moderate OHSS.4.The relationship between OHSS and ART pregnancy outcome showed that OHSS group could get more metaphase of second Meiosis,MII)(case group 16.69 ± 7.74 and control group 7.16 ± 4.62)/ number of fertilized eggs(case group 13.61 ± 7.06 and control group 5.72 ± 4.13),more total cleavage(case group 13.68 ± 6.87 and control group 5.67 ± 4.13),more normal fertilization(case group 11.06 ± 6.22 and control group 4.73 ± 3.63),more frozen embryos(case group 8.43 ± 4.24 and control group 3.67 ± 3.19),more frozen embryos The number of high quality embryos(5.31 ± 4.03 in case group and 2.51 ± 2.68 in control group)and more usable embryos(8.62 ± 4.20 in case group and 4.40 ± 3.22 in control group)and the cancellation rate of fresh embryo transfer(90.9% in case group and 60.3% in control group)were significantly higher than those in control group(P < 0.05),but there was no significant difference in clinical pregnancy rate(P > 0.05).Conclusions: 1.Gn-only regimen(compared with other regimens),trigger medicine HCG10000IU(0.1-0.2mg of dapica as control),E2 on HCG day <5000 pg / ml(compared with HCG day E2 ? 5000 pg / ml as control),E2?1000 pg / ml on the 6th day of Gn(compared with E2?1600 pg / ml on the 6th day of Gn as a control)were protective factors for OHSS;PCOS,history of intrauterine operation,E2?600pg / ml on the 4th day of Gn(Compared with E2> 900 pg / ml on day 4 of Gn as a control)were both risk factors for OHSS.2.Gn-only regimen(compared with other regimens),trigger medicine HCG10000IU(0.1-0.2mg of dapica as control),H2 E2 <5000 pg / ml(compared with HCG day E2 ? 5000 pg / ml as control),E2?1000 pg / ml on the 6th day of Gn(compared with E2?1600 pg / ml on the 6th day of Gn)were protective factor for the occurrence of mild OHSS;PCOS,history of intrauterine operation,E2?600 on the 4th day of Gn pg / ml(compared with E2> 900 pg / ml on the 4th day of Gn as a control)and 16-20 follicles observed on the day of HCG(compared with the number of follicles observed> 25 as controls)were risk factors for mild OHSS.3.Withdrawal of uterine effusion on the day of egg retrieval,basal FSH ? 5 m IU / ml(compared with basal FSH> 10 m IU / ml),E2 1301 ~ 1600 pg / ml on Gn 6th(E2 ? 1600 on Gn 6 pg / ml is the control)were risk factors for the occurrence of moderate OHSS;the number of eggs obtained by the antagonist protocol is ?15(and the number of eggs retrieved is> 25)was protective factors for the occurrence of moderate OHSS.4.Compared with patients without OHSS,patients with OHSS can obtain better IVF / ICSI outcomes(MII / fertilized eggs,total cleavage,normal fertilization,frozen embryos,high-quality embryos,and available embryos were higher),but the cancellation rate of fresh embryo transplantation cycle increased significantly,and there was no significant difference in clinical pregnancy rate.