In the OHSS (ovarian hyperstimulation syndrome) risk stratification, which serum marker on the day of hCG trigger most reliably predicts severe OHSS development in an IVF cycle?
- A Anti-Müllerian hormone (AMH) >3.5 ng/mL prior to stimulation
- B Serum oestradiol >3000 pg/mL on day of trigger ✓
- C Serum progesterone >1.5 ng/mL on day of trigger
- D Number of follicles >11 mm at time of trigger >18
Explanation
On the day of hCG trigger, serum oestradiol >3000 pg/mL (some guidelines use >2500–4000 pg/mL depending on assay) is a well-validated threshold for high risk of severe OHSS and triggers preventive strategies (GnRH agonist trigger instead of hCG, coasting, cryopreservation of all embryos with freeze-all strategy, or albumin administration). AMH is used to predict hyper-response risk before stimulation begins but does not predict OHSS on the day of trigger as precisely. Progesterone rise on trigger day predicts implantation failure rather than OHSS. Follicle count >15 at trigger is a quantitative risk factor but the serum oestradiol threshold is the most commonly cited biochemical cut-off.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.