Prediction of ovarian hyperstimulation syndrome (OHSS): Estradiol level versus follicular scoring system

Abstract

Objective: To determine a threshold level for estradiol (E2) and follicular score to predict OHSS. Study Design: This prospective study comprised 260 non-IVF induced ovulatory cycles. Serum E2 levels were measured. Follicular score was determined taking into consideration the summation of points obtained from both ovaries, as follows: 5 to 8 mm diameter= 1 point; 9 to 12 mm= 1.5 points; 13 to 16 mm= 2 points; >= 17 mm diameter= 3 points. We selected threshold levels for E2 as follows: 1000 pg/ml; 1500 pg/ml; and 2000 pg/ml. And for follicular scores as 20; 25; and 30. We calculated the sensitivity, specificity, positive and negative predictive values for each threshold level. Results: Mild degree of OHSS developed in 21 of 260 cycles (8.1%). The threshold value of 2000 pg/ml for E2 gave 100% specificity and positive predictive value, but sensitivity of 7.69% and negative predictive value of 48.67%. Follicular score of 30 points also yielded 100% specificity and positive predictive value, but sensitivity of 7.55% and negative predictive value of 48.18%. Conclusion: The thresholds value of 30 for follicular score and 2000 pg/ml for E2 gave the best spesificity and positive predictive value in order to predict the development of OHSS. However, both methods had low sensitivity and negative predictive value, therefore were non-reliable.