Dynamics of immuno­hormonal and ultrasound markers in predicting treatment outcomes in women at risk of ovarian hyperstimulation syndrome: multicenter analysis and prospects for personalized therapy

Abstract

DOI: 10.52705/2788-6190-2025-02.2-14
УДК: 618.177-089.888.11:618.11-007.61-006.04-073.43:616-092.9

Ovarian hyperstimulation syndrome (OHSS) remains one of the most serious complications of assisted reproductive technology (ART) programs, especially in women with high ovarian reserve.
The objective: to evaluate the effectiveness of personalized ovarian stimulation protocols aimed at preventing OHSS and improving reproductive outcomes in high-risk patients.
Materials and methods. A randomized prospective study was conducted involving 120 women at high risk of OHSS, allocated into subgroup A (n = 43), subgroup B (n = 37), and a control group (n = 40). Subgroups A and B received antagonist GnRH protocols, dual ovulation trigger (GnRH agonist ± low-dose hCG), dopamine agonists (cabergoline), enhanced luteal phase support, and a “Freeze all” strategy. The control group underwent standard stimulation with hCG trigger and basic luteal support. Monitoring included transvaginal ultrasound, anti-Müllerian hormone, estradiol, and progesterone levels.
Results. The incidence of clinically significant OHSS was 4.7% in subgroup A and 2.7% in subgroup B, compared to 17.5% in the control group (p < 0.05). Clinical pregnancy rates were 55.8% (A), 48.6% (B), and 35% (control, p < 0.05). Miscarriage rates were 9.1% (A), 10.8% (B), and 21.4% (control, p = 0.05). The number of retrieved oocytes and estradiol levels were comparable between groups. Personalized regimens reduced OHSS risk while maintaining high ART success rates.
Conclusions. A comprehensive personalized approach including modified stimulation protocols, dual trigger, dopamine agonists, and a “Freeze-all” strategy is an effective method for OHSS prevention in high-risk women and improves clinical pregnancy rates while reducing miscarriage incidence.