Biochemical predictors of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization: a retrospective cohort study from a tertiary fertility center in Pakistan

Abstract

Background: Ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of controlled ovarian stimulation during assisted reproductive technology. This study identified biochemical predictors and described outcomes of OHSS among women undergoing in vitro fertilization (IVF) at a tertiary fertility center in Khyber-Pakhtunkhwa, Pakistan. Methods: Records of 316 infertile women treated at the Center for Reproductive Medicine, Peshawar General Hospital, from December 2023 to December 2024 were reviewed. Patient characteristics, infertility diagnosis, treatment parameters, anti-Müllerian hormone (AMH), peak serum estradiol (E2), antral follicular count (AFC), and total oocytes retrieved were assessed. All patients received HCG Alpha 250 µg for final oocyte maturation. OHSS was classified using Golan and Weissman (2009) criteria. Analysis was performed using IBM SPSS Statistics v26.   Results: The mean age was 32.21±4.85 years and BMI 27.42±1.71 kg/m²; 69.6% had PCOS. Sixteen patients (5.06%) developed OHSS, all with PCOS as a contributing risk factor. 25.0% had moderate, 62.5% severe, and 12.5% had critical OHSS. Compared with non-OHSS patients, mean AFC (24 versus 13), AMH (6.5 versus 3.4 ng/ml), peak E2 (35 versus 18 ng/ml), and oocytes retrieved (15 versus 9) were higher. Nine (56.25%) achieved live birth, all after frozen embryo transfer. Conclusions: AFC, AMH, peak serum estradiol, and total oocytes retrieved are the principal biochemical markers associated with OHSS in this Pakistani IVF cohort. The universal use of standard hCG triggering in a PCOS-predominant population represents the most modifiable contributor to the high severity distribution observed from low - and -middle income country centers.