Plasma pentraxin 3 is higher in early ovarian hyperstimulation syndrome than in uncomplicated in vitro fertilization cycle of high-risk women

Kati Korhonen,Hanna Savolainen-Peltonen,Henrik Alfthan,Juha Tapanainen,Tomi Mikkola,Leila Unkila-Kallio,Esa Hämäläinen,Aila Tiitinen

doi:10.1007/s00404-020-05556-9

Abstract

PurposePentraxin 3 (PTX3) is a locally secreted, quicker responsive pro-inflammatory protein than C-reactive protein (CRP). We evaluated the value of PTX3 in the prediction of ovarian hyperstimulation syndrome (OHSS), a severe complication of in vitro fertilization (IVF).MethodsThis two-year prospective follow-up study included 27 women with uncomplicated IVF-cycles (IVF group) and 31 patients diagnosed with moderate or severe early OHSS (OHSS group). PTX3 was analysed from follicular fluid (FF) and serial blood samples with enzyme-linked immunoassay and CRP with particle-enhanced immunoturbidimetric assay. The value of PTX3 and CRP in detecting OHSS was examined with receiver operating characteristic (ROC) curve analysis and expressed as the area under the curve (AUC).ResultsThe circulating PTX3 level peaked at two days after oocyte pick-up (OPU2), and in the OHSS group the level was 1.9 times higher (P = 0.006) than in the IVF group. However, in ROC curve analysis PTX3 (AUC 0.79, best cut off 1.1 µg/L) was not superior to CRP (AUC 0.87; best cut off 9.5 mg/L) in predicting early OHSS. In the IVF group, the FF-PTX3 concentration was 15–20 times higher than in the plasma. PTX3 level at OPU2 correlated with the number of punctured follicles (r = 0.56, n = 22, P = 0.006). Triggering with human chorionic gonadotrophin or early pregnancy had no effect on PTX3 level.ConclusionThe elevated PTX3 concentration in OHSS at OPU2, when freeze-all embryos strategy is still possible to consider, indicates that PTX3 level could provide additional benefit in the risk assessment for early OHSS.

Highlights

Ovarian hyperstimulation syndrome (OHSS) is the most severe complication of in vitro fertilization (IVF) [1, 2] and inflammation, endothelial dysfunction and increased capillary permeability play a profound role in its pathophysiology
The power analysis revealed that the sample size of ten is sufficient to detect one standard deviation difference in Pentraxin 3 (PTX3) level between the IVF and OHSS groups
Plasma PTX3 was higher in early OHSS than in the uncomplicated IVF cycle, it was not superior to the traditionally used inflammatory marker C-reactive protein (CRP) in predicting early OHSS

Summary

Introduction

Ovarian hyperstimulation syndrome (OHSS) is the most severe complication of in vitro fertilization (IVF) [1, 2] and inflammation, endothelial dysfunction and increased capillary permeability play a profound role in its pathophysiology. The concentrations of several proinflammatory cytokines and C-reactive protein (CRP) are increased in OHSS [3,4,5], but none of them has so far been shown useful in predicting the syndrome. Unlike the liver-produced CRP, PTX3 is secreted i.e. from activated endothelial cells and macrophages, and from the ovarian granulosa cells [11,12,13]. High PTX3 concentration has been associated with endothelial dysfunction [14], and increasing data indicate that PTX3 is a prognostic factor for diverse

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Conclusion