Value of the serum estradiol level for preventing ovarian hyperstimulation syndrome: a retrospective case control study

Objective: To assess the value of different serum E-2 cut-off levels for predicting women at risk for ovarian hyperstimulation syndrome (OHSS). Design: Retrospective case-control study of a cohort of women undergoing assisted reproduction treatment (ART) over 12 months. Setting: Tertiary university hospital. Patient(s): The study group included women with OHSS who fulfilled the endocrine inclusion criteria (n = 40). The control group was a random sample (n = 40) from the cohort of women undergoing ART. Interventionts): None. Main Outcome Measure(s): To evaluate the sensitivity and specificity of different serum E2 cut-off levels on day 11 of ovarian stimulation in preventing the establishment of OHSS. Result(s): Three hundred ninety-nine cycles (IVF and intracytoplasmic sperm injection) were undertaken between June 2000 and May 2001. The study group (n = 40) was compared with the control group (n = 40) undergoing ART during the same period of time. On day 8 of ovarian stimulation, the mean (SD) E-2 level in the study group was 8,517(5.3) pmol/L (2,320 pg/mL), and in the control group it was 2,540 (2.6) pmol/L (691 pg/mL). On day 11 of stimulation the mean (SD) E-2 level was 15,662 (4.2) pmol/L (4,266 pg/mL)and 5,804 (4.5) pmol/L (1,581 pg/mL), respectively. Twenty-four (60%) women who developed OHSS had E-2 levels >6,000 pmol/L (1,634 pg/mL) on day 8 and above 11,000 pmol/L (2,996 pg/mL) on day 11. Sixteen (40%) had E-2 levels <6,000 pmol/L (1,634 pg/mL) on day 8, but all had levels above 11,000 pmol/l (2,996 pg/mL) on day 11. Conclusion(s): A serum E-2 level of 12,315 pmol/L (3,354 pg/mL) on day 11 of ovarian stimulation gives a sensitivity and specificity of 85% for the detection of women at risk for OHSS. (C) 2004 by American Society for Reproductive Medicine.