Abstract
BackgroundOvarian hyperstimulation syndrome (OHSS) is an iatrogenic condition characterized by capillary hyperpermeability which can be predicted by preovulatory ovarian responses such as number of follicles. A variety of cytokines are thought to be involved in pathophysiology of this syndrome.MethodsA prospective cohort study invloving sixty intracytoplasmic sperm injection (ICSI) patients. On the day of hCG injection, we explored the threshold of larger follicles ≥11 mm diameter with a count of ≥18 follicles for the high-risk moderate-to-severe OHSS and 13–18 follicles for the low-risk moderate-to-severe OHSS. Whereas larger follicles count of less than 13 were classified as normoresponders. Pooled follicular fluid (FF) samples of each patient were collected on the day of oocyte retrieval. Magnetic multiplex immunoassay was explored to measure the concentrations of some intrafollicular cytokines including: GM-CSF, INF-γ, TNF-α, IL-10, CXCL8/IL-8, IL-6, IL-5, IL-4, IL-2, and IL-1β. All sixty patients underwent controlled ovarian hyperstimulation (COH) with either GnRH agonist or antagonist protocols.ResultsIntrafollicular TNF-α concentration was significantly different (p < 0.05) in the high-risk moderate-to-severe OHSS patients compared to low-risk moderate-to-severe OHSS patients and normoresponders. TNF-α in FF had a negative correlation with the chance of high-risk moderate-to-severe OHSS. The differences in the risk of OHSS between patients who received GnRH agonist or antagonist were not significant (p > 0.05).ConclusionsIn accordance to the negative correlation of TNF-α and high risk of early OHSS, we did not expect TNF-α to play a role in increasing vascular permeability in ovarian tissues. In addition, the risk of early moderate-to-severe OHSS was not affected by different GnRH superovulation protocols.
Highlights
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition characterized by capillary hyperpermeability which can be predicted by preovulatory ovarian responses such as number of follicles
OHSS occurs about 1–9 days after human chorionic gonadotropin treatment and is related to gonadotropin administration [2]
An increase of each picogram of Tumor necrosis Factor- α (TNF-α) in follicular fluid decreased the chance of moderate-to-severe OHSS approximately by one third (p = 0.001; OR = 0.27)
Summary
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition characterized by capillary hyperpermeability which can be predicted by preovulatory ovarian responses such as number of follicles. OHSS occurs about 1–9 days after human chorionic gonadotropin (hCG) treatment and is related to gonadotropin administration [2]. It can be predicted by in-time preovulatory ovarian response to institute preventative methods [3]. The definitive physiologic mechanism of OHSS is not yet identified, there are well-known risk factors that must be considered during the administration of medications for infertility treatment [1] It seems that a combination of non-immune (e.g. hCG, renin-angiotensin system and luteinizing hormone (LH)) and immune (e.g. cytokines) mechanisms may allow a profound understanding of this syndrome. The relationship found between plasma cytokine activities and the severity of this syndrome proposes that plasma cytokines may be involved in the pathogenesis of OHSS and may act as a means of checking the syndrome [5]
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