The continuum of high ovarian response: a rational approach to the management of high responder patient subgroups

Figures & data

Table 1. Published criteria for risk for high ovarian response, risk for OHSS, and definition of high ovarian response.

Criteria	Risk for High response	High response	Risk for OHSS
Age < 40	[Datta et al. 2014]		[Datta et al. 2014]
AMH^1> 21–25 pmol/l	[Datta et al. 2014; Nastri et al. 2015]		[Lee et al. 2008]
AMH > 40 pmol/l			[Iliodromiti et al. 2013]
PCOS diagnosis	[Datta et al. 2014]		[Humaidan et al. 2010a]
Previous OHSS			[Humaidan et al. 2010a]
AFC^2> 12–16	[Nastri et al. 2015]
>15 retrieved oocytes		[Hamdine et al. 2015; Wu et al. 2013]
>18 retrieved oocytes		[Broekmans et al. 2014]
>20 retrieved oocytes		[Lin et al. 2013; Shapiro et al. 2011]
Peak E2^3> 2,500 pg/ml (∼9,200 pmol/L]		[Shapiro et al. 2011]
Peak E2 > 4,000 pg/ml (∼14,700 pmol/L]		[Lin et al. 2013]	[Iliodromiti et al. 2013]
>13 follicles ≥11 mm on triggering day		[Griffin et al. 2012; Humaidan et al. 2013; Iliodromiti et al. 2013; Radesic and Tremellen 2011]	[Humaidan et al. 2010a]
>13 follicles ≥11 mm on 8–9 stimulation day			[Iliodromiti et al. 2013; Radesic and Tremellen 2011]

OHSS: ovarian hyperstimulation syndrome; ¹AMH: anti-müllerian hormone; ²AFC: antral follicles count; ³E2: estradiol.

Figure 1. Chronological evaluation of high ovarian response and OHSS development. PCOS: polycystic ovary syndrome; AMH: anti-müllerian hormone; AFC: antral follicle count; PCO: polycistic ovary; US: ultrasound; OHSS: ovarian hyperstimulation syndrome; E2: estradiol.

Figure 2. Classification and clinical management of the high ovarian response continuum. Positive and negative predictive values as well as level of evidence are presented in Supplemental Table 1. ¹One of the following: AMH > 3 ng/ml, AFC > 16, PCOS/PCOM, previous high response (OHSS, cycle cancellation or coasting) [Engmann et al. 2008; Humaidan et al. 2013; Nastri et al. 2015]. ²∼14,700 pmol/L. GnRH: Gonadotropin realising hormone; GnRHa: Gonadotropin realising hormone agonist; LPS: luteal phase support; hCG: human chorionic gonadotropin; PCOS: polycystic ovary syndrome; AMH: anti-müllerian hormone; AFC: antral follicle count; PCO: polycistic ovary; US: ultrasound; OHSS: ovarian hyperstimulation syndrome; E2: estradiol.

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