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Abstract：
OBJECTIVE: To provide an agreed upon definition of hyper-response for women undergoing ovarian stimulation (OS)?
METHODS: A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the questionnaire for the first round of the Delphi consensus. The questionnaire was distributed to 31 experts, 22 of whom responded (with representation selected for global coverage), each anonymous to the others. A priori, it was decided that consensus would be reached when ≥ 66% of the participants agreed and ≤ 3 rounds would be used to obtain this consensus.
RESULTS: 17/18 statements reached consensus. The most relevant are summarized here. (I) Definition of a hyper-response: Collection of ≥ 15 oocytes is characterized as a hyper-response (72.7% agreement). OHSS is not relevant for the definition of hyper-response if the number of collected oocytes is above a threshold (≥ 15) (77.3% agreement). The most important factor in defining a hyper-response during stimulation is the number of follicles ≥ 10 mm in mean diameter (86.4% agreement). (II) Risk factors for hyper-response: AMH values (95.5% agreement), AFC (95.5% agreement), patient\'s age (77.3% agreement) but not ovarian volume (72.7% agreement). In a patient without previous ovarian stimulation, the most important risk factor for a hyper-response is the antral follicular count (AFC) (68.2% agreement). In a patient without previous ovarian stimulation, when AMH and AFC are discordant, one suggesting a hyper-response and the other not, AFC is the more reliable marker (68.2% agreement). The lowest serum AMH value that would place one at risk for a hyper-response is ≥ 2 ng/ml (14.3 pmol/L) (72.7% agreement). The lowest AFC that would place one at risk for a hyper-response is ≥ 18 (81.8% agreement). Women with polycystic ovarian syndrome (PCOS) as per Rotterdam criteria are at a higher risk of hyper-response than women without PCOS with equivalent follicle counts and gonadotropin doses during ovarian stimulation for IVF (86.4% agreement). No consensus was reached regarding the number of growing follicles ≥ 10 mm that would define a hyper-response.
CONCLUSIONS: The definition of hyper-response and its risk factors can be useful for harmonizing research, improving understanding of the subject, and tailoring patient care.
METHODS: A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the questionnaire for the first round of the Delphi consensus. The questionnaire was distributed to 31 experts, 22 of whom responded (with representation selected for global coverage), each anonymous to the others. A priori, it was decided that consensus would be reached when ≥ 66% of the participants agreed and ≤ 3 rounds would be used to obtain this consensus.
RESULTS: 17/18 statements reached consensus. The most relevant are summarized here. (I) Definition of a hyper-response: Collection of ≥ 15 oocytes is characterized as a hyper-response (72.7% agreement). OHSS is not relevant for the definition of hyper-response if the number of collected oocytes is above a threshold (≥ 15) (77.3% agreement). The most important factor in defining a hyper-response during stimulation is the number of follicles ≥ 10 mm in mean diameter (86.4% agreement). (II) Risk factors for hyper-response: AMH values (95.5% agreement), AFC (95.5% agreement), patient\'s age (77.3% agreement) but not ovarian volume (72.7% agreement). In a patient without previous ovarian stimulation, the most important risk factor for a hyper-response is the antral follicular count (AFC) (68.2% agreement). In a patient without previous ovarian stimulation, when AMH and AFC are discordant, one suggesting a hyper-response and the other not, AFC is the more reliable marker (68.2% agreement). The lowest serum AMH value that would place one at risk for a hyper-response is ≥ 2 ng/ml (14.3 pmol/L) (72.7% agreement). The lowest AFC that would place one at risk for a hyper-response is ≥ 18 (81.8% agreement). Women with polycystic ovarian syndrome (PCOS) as per Rotterdam criteria are at a higher risk of hyper-response than women without PCOS with equivalent follicle counts and gonadotropin doses during ovarian stimulation for IVF (86.4% agreement). No consensus was reached regarding the number of growing follicles ≥ 10 mm that would define a hyper-response.
CONCLUSIONS: The definition of hyper-response and its risk factors can be useful for harmonizing research, improving understanding of the subject, and tailoring patient care.
摘要：
目的：为接受卵巢刺激（OS）的女性提供一致的超反应定义？
方法：对辅助生殖技术的卵巢刺激超反应进行了文献检索。由5名专家组成的科学委员会进行了讨论，修正,并选择了第一轮德尔菲共识问卷中的最终陈述。问卷已分发给31位专家,其中22人作出答复(选定代表进行全球覆盖)，每个人都是匿名的。先验,决定在≥66％的参与者同意时达成共识，并使用≤3轮获得共识。
结果：17/18声明达成共识。最相关的总结在这里。(I)超反应的定义:收集≥15个卵母细胞被表征为超反应(72.7%一致)。如果收集的卵母细胞数量高于阈值（≥15）（77.3％的一致性），则OHSS与超反应的定义无关。在刺激过程中定义过度反应的最重要因素是平均直径≥10mm的卵泡数（86.4％的一致性）。（二）超反应的危险因素：AMH值（95.5%一致），AFC（同意95.5%），患者年龄（77.3%同意），但不包括卵巢体积（72.7%同意）。在以前没有卵巢刺激的患者中，高反应的最重要危险因素是窦卵泡计数(AFC)(68.2%的一致性).在以前没有卵巢刺激的患者中，当AMH和AFC不一致时，一个暗示过度反应，另一个没有，AFC是更可靠的标记(68.2%的一致性)。将一个人置于过度反应风险的最低血清AMH值为≥2ng/ml（14.3pmol/L）（72.7％一致）。将一个人置于过度反应风险的最低AFC为≥18(81.8%同意)。根据鹿特丹标准患有多囊卵巢综合征（PCOS）的女性在IVF的卵巢刺激期间，与没有PCOS的女性相比，具有相同卵泡计数和促性腺激素剂量的女性具有更高的高反应风险（86.4％同意）。对于生长中的卵泡数≥10mm，这将定义过度反应，未达成共识。
结论：超反应及其危险因素的定义有助于协调研究，提高对主题的理解，和定制病人护理。
方法：对辅助生殖技术的卵巢刺激超反应进行了文献检索。由5名专家组成的科学委员会进行了讨论，修正,并选择了第一轮德尔菲共识问卷中的最终陈述。问卷已分发给31位专家,其中22人作出答复(选定代表进行全球覆盖)，每个人都是匿名的。先验,决定在≥66％的参与者同意时达成共识，并使用≤3轮获得共识。
结果：17/18声明达成共识。最相关的总结在这里。(I)超反应的定义:收集≥15个卵母细胞被表征为超反应(72.7%一致)。如果收集的卵母细胞数量高于阈值（≥15）（77.3％的一致性），则OHSS与超反应的定义无关。在刺激过程中定义过度反应的最重要因素是平均直径≥10mm的卵泡数（86.4％的一致性）。（二）超反应的危险因素：AMH值（95.5%一致），AFC（同意95.5%），患者年龄（77.3%同意），但不包括卵巢体积（72.7%同意）。在以前没有卵巢刺激的患者中，高反应的最重要危险因素是窦卵泡计数(AFC)(68.2%的一致性).在以前没有卵巢刺激的患者中，当AMH和AFC不一致时，一个暗示过度反应，另一个没有，AFC是更可靠的标记(68.2%的一致性)。将一个人置于过度反应风险的最低血清AMH值为≥2ng/ml（14.3pmol/L）（72.7％一致）。将一个人置于过度反应风险的最低AFC为≥18(81.8%同意)。根据鹿特丹标准患有多囊卵巢综合征（PCOS）的女性在IVF的卵巢刺激期间，与没有PCOS的女性相比，具有相同卵泡计数和促性腺激素剂量的女性具有更高的高反应风险（86.4％同意）。对于生长中的卵泡数≥10mm，这将定义过度反应，未达成共识。
结论：超反应及其危险因素的定义有助于协调研究，提高对主题的理解，和定制病人护理。
