Table 2.

The consensus statements

Definitions of a hyper-response
Hyper-response is characterized by the collection of ≥ 15 oocytes
A history of a hyper-response or OHSS in a prior cycle is not required to define a hyper-responder
OHSS is not relevant for the definition of hyper-response if the number of collected oocytes is above a threshold (≥ 15)
Recognition of pending hyper-response during ovarian stimulation
The most important factor in defining a hyper-response during the ovarian stimulation is the number of follicles ≥ 10 mm in mean diameter
Risk factors for a hyper-response – risk factors prior to OS
I consider the serum Anti Mullerian Hormone (AMH) levels when assessing the risk for a possible hyper-response
I consider the antral follicular count (AFC) when assessing the risk for a possible hyper-response
I consider the patient’s age when assessing the risk for a possible hyper-response
I do not consider the ovarian volume when assessing the risk for a possible hyper-response
In a patient without a previous ovarian stimulation, the most important risk factor for a hyper-response is the antral follicular count (AFC)
In a patient without a previous ovarian stimulation, when AMH and AFC are discordant, with one suggesting a hyper-response and the other not, AFC is the more reliable marker
Hyper-response can occur at any age
The lowest serum AMH value that would put a woman at risk for a hyper-response is ≥ 2 ng/ml (14.3pMol/L)
The lowest AFC that would put a woman at risk for a hyper-response is ≥ 18
A patient with a history of hyper-response in a previous stimulation cycle would be considered at high risk for another hyper-response if there was no significant change in the serum AMH levels and the AFC (± 3 follicles)
Women with the 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 used to stimulate
Risk factors for a hyper-response—Risk factors for hyper-response during ovarian stimulation
The lowest number of growing follicles ≥ 14 mm that would characterize a hyper-response to ovarian stimulation is ≥ 15 follicles
The lowest peak estradiol level that would indicate a hyper-response to ovarian stimulation is ≥ 3,000pg/ml (11,013pMol/l)

^* No consensus was reached regarding the number of growing follicles ≥ 10 mm that would define a hyper-response

OS – ovarian stimulation