New insights in prediction of ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome is the most dangerous complication following the administration of gonadotropins. There is no preventive and pharmacological intervention that can fully prevent development of this syndrome. The best strategy to reduce the incidence of the condition is to identify the patients at risk before ovarian stimulation and to recognize potential predictors. A history of ovarian hyperstimulation is an important risk factor for recurrence of the syndrome. The risk of the syndrome is evident with elevated gonadotropin dosages and with the use of gonadotropin releasing hormone agonists. Human chorionic gonadotropin is the main risk factor. The combination of pretreatment diagnosis of polycystic ovary disease and estradiol of 4500 pg/ mL gives higher prediction rates for the risk factor. Serum concentration of inhibin is not a reliable predictor of the syndrome. Recent evaluation of antimüllerian hormone as a reliable predictor candidate, vascular endothelial growth factor with cadherin as indicators of vascular permeability, and detection of mutations in the follicular stimulating hormone receptor as predictors of severity offer new insights in the prognosis of the syndrome. Identification of these prognostic markers in patients at risk would be very useful for prevention of the syndrome prior to the appearance of symptoms.