Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal study.

Guluzar Arzu Turan,Osman Yilmaz,Esra Bahar Gur,Hakan Cengiz,Nur Sahin,Saban Adakan,Sumeyra Tatar,Oya Nermin Sivrikoz,Fatma Eskicioglu

doi:10.1007/s00404-015-3747-5

Abstract

PurposeTo evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS.MethodsIn this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels.ResultsVascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group.ConclusionsOur data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.

Highlights

Ovarian hyperstimulation syndrome (OHSS) arises as an iatrogenic complication of assisted reproductive technology (ART)
While pigment epithelium-derived factor (PEDF) expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group
There was no significant difference in serum PEDF levels between groups

Summary

Introduction

Ovarian hyperstimulation syndrome (OHSS) arises as an iatrogenic complication of assisted reproductive technology (ART). OHSS is defined by enlarged ovarian cysts and fluid leakage into the third space secondary to increased capillary permeability. Severe cases are potentially life-threatening and are characterized by acute respiratory distress syndrome (ARDS), hypovolemia, ascites, edema, and thrombosis [1]. The pathophysiology of OHSS is not fully understood, an increased vascular permeability due to the. Vascular endothelial growth factor (VEGF) plays a key role in increased vascular permeability [2]. VEGF production is regulated by arachidonic acid metabolites and nitric oxide (NO) produced by nitric oxide synthase (NOS) and cyclooxygenase type 2 (COX-2) [3]. It has been shown that COX-2 inhibitors reduce ovarian expression of VEGF and COX-2 in the rat model of OHSS [4]

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