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

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.