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Objective <p>To develop a practical, pre-trigger risk scoring system using routinely available clinical parameters to predict moderate-to-severe ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) cycles.</p> Methods <p>We retrospectively analyzed women undergoing their first fresh IVF/ICSI cycle between January 2018 and July 2025. Only pre-trigger variables were included. Univariable logistic regression identified candidate predictors, which were entered into multivariable logistic regression with backward selection. Regression coefficients were converted into an integer-based risk score. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration, and internal bootstrap validation.</p> Results <p>A total of 1,641 women were included, of whom 125 (7.6%) developed moderate-to-severe OHSS. Younger age, higher AMH, lower FSH and E2, elevated LH/FSH ratio, and polycystic ovary syndrome (PCOS) were independently associated with OHSS. These six predictors were incorporated into a 0–13 point scoring system. OHSS incidence increased progressively with higher scores, enabling clinically meaningful stratification into low-, moderate-, high-, and very high-risk categories. The model demonstrated good discrimination (AUC 0.84; 95% CI 0.81–0.87) and excellent calibration (Hosmer–Lemeshow <i>p</i> = 0.61). Bootstrap validation confirmed robust performance with minimal optimism. The score retained predictive utility in both PCOS and non-PCOS subgroups.</p> Conclusion <p>We developed a simple, pre-trigger risk scoring system that reliably predicts moderate-to-severe OHSS prior to final oocyte maturation, supporting proactive prevention and individualized stimulation strategies. External and prospective multicenter validation is warranted.</p>

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Pre-trigger risk scoring for moderate-to-severe ovarian hyperstimulation syndrome in in vitro fertilization and intracytoplasmic sperm injection cycles

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月7日

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  • Lina He,
  • Wei Chen,
  • Jie Lin,
  • Li Hao,
  • Fuming Wan,
  • Yanhong Fu,
  • Qiongyu Wu,
  • Xu Ran,
  • Zhengwen Qin

摘要

Objective

To develop a practical, pre-trigger risk scoring system using routinely available clinical parameters to predict moderate-to-severe ovarian hyperstimulation syndrome (OHSS) in in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) cycles.

Methods

We retrospectively analyzed women undergoing their first fresh IVF/ICSI cycle between January 2018 and July 2025. Only pre-trigger variables were included. Univariable logistic regression identified candidate predictors, which were entered into multivariable logistic regression with backward selection. Regression coefficients were converted into an integer-based risk score. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration, and internal bootstrap validation.

Results

A total of 1,641 women were included, of whom 125 (7.6%) developed moderate-to-severe OHSS. Younger age, higher AMH, lower FSH and E2, elevated LH/FSH ratio, and polycystic ovary syndrome (PCOS) were independently associated with OHSS. These six predictors were incorporated into a 0–13 point scoring system. OHSS incidence increased progressively with higher scores, enabling clinically meaningful stratification into low-, moderate-, high-, and very high-risk categories. The model demonstrated good discrimination (AUC 0.84; 95% CI 0.81–0.87) and excellent calibration (Hosmer–Lemeshow p = 0.61). Bootstrap validation confirmed robust performance with minimal optimism. The score retained predictive utility in both PCOS and non-PCOS subgroups.

Conclusion

We developed a simple, pre-trigger risk scoring system that reliably predicts moderate-to-severe OHSS prior to final oocyte maturation, supporting proactive prevention and individualized stimulation strategies. External and prospective multicenter validation is warranted.