Follicular Fluid Of Patients Research Articles

Evaluation of sFas in serum and follicular fluid during ovarian stimulation for assisted reproduction

To measure the level of sFas in serum and follicular fluid (FF) from infertile women undergoing exogenous gonadotropin stimulation as a part of IVF/ICSI cycles and to study its correlation with oocyte maturation, fertilization, and embryo quality. Serum and FF samples were obtained from 55 patients at the time of transvaginal oocyte retrieval after ovulation induction for assisted reproduction. sFas levels in the serum and FF were measured in duplicate by a solid phase enzyme-linked immunosorbent assay (ELISA). E2 levels were measured by an enzyme immunoassay. There was no statistically significant correlation between age and sFas levels in serum ( p =0.84, r =−0.35) or follicular fluid ( p =0.75, r =−0.36). It was observed that the levels of sFas in serum and FF vary with different patients’ diagnosis. There was a statistically significant increase in sFas levels in both serum ( p =0.023, r =0.08) and FF ( p =0.014, r =0.01) in patients with uterine causes of infertility (subseptate uterus and previous myomectomy) compared with those having other causes of infertility. sFas were detected in low concentration in serum and FF in patients with male factor and idiopathic causes of infertility ( Fig. 1 ). A positive correlation was found between the sFas levels in the serum and those in the FF ( p =0.01, r =0.91) ( Fig. 2 ). However, no correlation was found between the levels of sFas and the levels of estradiol in the serum ( p =0.427, r =−0.03). There was a significant correlation between the number of fertilized oocytes and the level of sFas in the serum ( p =0.013, r =−0.42) ( Fig. 3 ). There was no correlation between the number of fertilized oocytes and the level of sFas in FF ( p =0.168, r =−0.40). However, a significant correlation between the levels of sFas in the serum of pregnant ( n =11) and non-pregnant women ( n =44) was observed ( p =0.045, r =0.90) ( Fig. 4 ). A lower level of sFas in serum was associated with a higher pregnancy rates. This may be attributed to the presence of good fertilized oocytes. The above phenomena may suggest that low levels of sFas in serum may be associated with improved implantation of fertilized oocytes or may prevent damage to the embryo. Lower levels of sFas seem to support embryo implantation.

Changes in plasma müllerian-inhibiting substance and brain-derived neurotrophic factor after chemotherapy in premenopausal women

Eight premenopausal women with cancer had blood drawn for analysis of brain-derived neurotrophic factor (BDNF) and müllerian-inhibiting substance (MIS) before and 3 months after receiving chemotherapy. Unlike MIS, BDNF levels were not reduced after chemotherapy.

Intrafollicular and serum levels of leptin during in vitro fertilization cycles: comparison between the effects of recombinant follicle-stimulating hormones and human menopausal gonadotrophin

Objectives. To compare the effect of recombinant follicle-stimulating hormones (r-FSH) and human menopausal gonadotrophin (hMG) on leptin levels in serum and follicular fluid (FF) during in vitro fertilization IVF/ET treatment, and to investigate whether leptin levels in the follicular fluid and/or serum are correlated with IVF success.Methods. Sixty-three patients undergoing IVF cycle were subdivided into two groups. r-FSH was used to for controlled ovarian hyperstimulation in 29 patients (Group A) while, hMG was used in 34 patients (Group B). Our main outcomes were serum and FF leptin on the day of oocyte collection.Result(s). The two groups were comparable in age, body mass index (BMI), indications for IVF/ET, E2 level on human chorionic gonadotrophin day, number of retrieved oocytes, fertilization rate, number of transferred embryos and pregnancy rate. Serum and FF leptin levels were similar between the two study groups. Additionally, no correlation was found between levels of leptin in either serum or FF and cycle results such as: number of retrieved oocytes, fertilization rate and pregnancy rate.Conclusions. r-FSH and hMG have been found to have comparable effects on leptin levels in the serum and the FF of patients undergoing IVF/ET. Additionally, leptin levels in both serum and FF on day of retrieval have no correlation to IVF/ET outcome.

Increased monocyte chemoattractant protein-1 levels indicating early vascular damage in lean young PCOS patients

Serum levels of monocyte chemoattractant protein-1 and C-reactive protein levels, as early signs of vascular damage and cardiovascular disease, were increased in young, lean patients with polycystic ovary syndrome. Serum monocyte chemoattractant protein-1 levels were positively correlated with serum LH, T, and C-reactive protein levels.

Multivitamin and mineral supplementation modulates oxidative stress and antioxidant vitamin levels in serum and follicular fluid of women undergoing in vitro fertilization

We investigated effects of multivitamin and mineral supplementation on lipid peroxidation, reduced glutathione, glutathione peroxidase, vitamin A, vitamin C and vitamin E values in serum and follicular fluid of 56 women undergoing IVF and 13 age matched control. We concluded that multivitamin and mineral supplementation in serum and follicular fluid of women undergoing IVF may strengthen the antioxidant defense system by decreasing oxidative stress.

Increased ENA‐78 in the follicular fluid of patients with endometriosis

It is known that endometriosis is an inflammatory disease and those patients seem to have lower pregnancy rates. The aim of the study was to investigate the concentrations of chemokines and proinflammatory cytokines in the follicular fluid of patients with and without endometriosis. Follicular aspiration, recovering follicular fluid during assisted reproductive treatment, follicular fluid storage and analysis of chemokines and proinflammatory cytokines were carried out. Tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, interleukin-8, interleukin-15, leukemia inhibitory factor, epithelial neutrophil-activating peptide 78, regulated upon activation, normal T-cell expressed and secreted, and growth-regulated oncogene-alpha were analyzed in the follicular fluid and compared between women with (n =47) and without endometriosis (n = 279). The above cytokines were detected in the follicular fluid samples. Epithelial neutrophil-activating peptide 78 levels were significantly higher in follicular fluid from endometriosis patients than from controls (p = 0.008). Increases (to twice the control level) were also observed for tumor necrosis factor-alpha and for interleukin-6. Increased follicular fluid levels of epithelial neutrophil-activating peptide 78, tumor necrosis factor-alpha and interleukin-6 indicate that these cytokines may influence oocyte quality and fecundability of women with endometriosis by deteriorating the microenvironment in the human follicle.

Natural killer cells and reproductive failure

The purpose of this review is to provide an update of what is known about the role of natural killer cells in reproduction. In humans, natural killer cells are present in abundance in the uterus and appear to play an important role in early pregnancy. Women with reproductive failure have been shown to have higher levels of natural killer cell numbers and activity in peripheral blood. The evidence relating to uterine natural killer cells, however, is contradictory. While earlier studies suggested an increase of uterine natural killer cells in women with recurrent pregnancy loss, more recent investigations have not confirmed this trend. Uterine natural killer cell number or activity appear to be higher in spontaneous abortions with normal chromosomes compared with chromosomally abnormal pregnancies. Furthermore, a rise of the cytotoxic CD56(dim)CD16+ natural killer cell subset is seen in the follicular fluid of patients with idiopathic infertility and it is postulated that this increase may decrease fertilization rates in this group. Natural killer cell number and activity appear to be altered in women with reproductive failure although it is unclear if the difference is a cause or effect of reproductive failure. Whether natural killer cells are increased or decreased depends on whether peripheral blood, endometrium or first-trimester decidua is analyzed. Until more is known about the role of natural killer cells in normal pregnancy, there does not appear to be any benefit in offering natural killer cell testing to women with reproductive failure outside of research protocols.

Increased concentration of vascular endothelial growth factor in the follicular fluid of patients with endometriosis does not affect the outcome of in vitro fertilization–embryo transfer

Vascular endothelial growth factor (VEGF) is a mitogen and a key regulator of angiogenesis. In vivo, it plays important roles in morphogenesis and chemoattraction, and is a powerful mediator for vessel permeability. The VEGF family of angiogenic molecules is involved in angiogenesis in both normal and pathologic conditions (1, 2).

Decreased expression of tissue inhibitor of matrix metalloproteinases in follicular fluid from women with polycystic ovaries compared with normally ovulating patients undergoing in vitro fertilization

Objective To compare activity of matrix metalloproteinases (MMP) and expression of their tissue-specific inhibitor (TIMP) in the follicular fluid of normally ovulating women and women with the polycystic ovary syndrome (PCOS). Design Prospective study. Setting IVF unit and endocrine research unit. Patient(s) Fourteen patients undergoing IVF treatment (seven with normal ovulation and seven with PCOS). Main outcome measure(s) Activity of MMP-2 and MMP-9 and expression of MMP-1, TIMP-1, and TIMP-2 was measured in follicular fluid of the leading follicles by using gel zymography and immunoblot analysis. Result(s) The activity of MMP-2 and MMP-9 and expression of MMP-1 was similar in follicular fluid of normally ovulating patients and patients with PCOS. Significantly lower expression of TIMP-1 was found in follicular fluid of patients with PCOS women compared with normally ovulating patients. Conclusion(s) Because MMPs and TIMPs play a role in the physical and chemical structure of the follicular compartment, the decreased expression of TIMP in patients with PCOS may be part of a compensatory process to overcome the physical properties of the thick ovarian capsule.

Insulin-like growth factor (IGF)-1 and IGF binding protein-1 and -3 in the follicular fluid of infertile patients with endometriosis.

Endometriosis is associated with pituitary-ovarian axis dysfunction. The study of the follicular fluid in patients with endometriosis is important to elucidate the pathophysiological mechanism of this disease. The objective of this present paper was to analyse the dosages of insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 and 3 (IGFBP-1 and IGFBP-3) in the follicular fluid environment of infertile patients with endometriosis. A total of 41 infertile patients undergoing IVF between January 1999 and January 2000 participated in the cross-sectional prospective study. Patients were divided into three groups: group I, minimal/mild endometriosis (n = 12); group II, moderate/severe endometriosis (n = 10); and group III, tubal obstruction (n = 19). The ultra-short protocol was used in association with recombinant FSH for ovulation induction. Follicular fluid analysis was performed using radioimmunoassay with specific kits. Follicular fluid IGF-1 and IGFBP-3 levels were not significantly different among the groups; however, follicular fluid IGFBP-1 levels were lower in those patients with moderate/severe endometriosis (P < 0.05). Comparison of ovulation induction time, number of recombinant FSH units, number of follicles, oocytes and embryos, and fertilization and gestation/cycle rates showed non-significant differences. Infertile patients with moderate/severe endometriosis, which is associated with ovulatory dysfunction, presented lower levels of IGFBP-1 in the follicular fluid when undergoing IVF.

Vascular endothelial growth factor, interleukin-6 and interleukin-2 in serum and follicular fluid of patients with ovarian hyperstimulation syndrome

Background: the pathogenesis of ovarian hyperstimulation syndrome (OHSS) is not completely understood. Objective: to investigate the presence of VEGF, IL-6 and IL-2, in serum and follicular fluid, in patients developing severe OHSS. Study design: we enrolled 101 women undergoing in vitro fertilization. Eight patients developing severe OHSS were compared with 43 high risk patients and 50 controls. We analyzed VEGF and IL-6 in serum collected before hCG administration, and in both serum and follicular fluid on the day of oocyte retrieval. Results: OHSS patients presented follicular fluid IL-6 levels higher than both the patients at risk and controls ( P<0.05). On the day of the oocyte retrieval the patients developing OHSS showed serum and follicular VEGF values higher than the ones of the patients at risk ( P<0.05). Serum and follicular fluid IL-2 levels showed no differences between the examined groups. IL-2, IL-6 and VEGF values were not correlated with each other. Conclusions: angiogenesis and inflammation processes are both present in severe OHSS.

Leptin and pregnancy outcome.

Leptin, a recently discovered hormone that is involved in the regulation of body weight, appears to be one of the hormonal factors that signal the body's readiness for sexual maturation and reproduction to the brain. The present review focuses on clinical and experimental studies that describe the roles of maternal and foetal leptin as predictive factors for the physiological and pathophysiological development of the foetus during pregnancy, assisted reproduction and neonatal life. Through evaluating alterations of maternal serum leptin levels, a physiological hyperleptinaemia has been observed to occur, particularly during the second and third trimesters of pregnancy, which is not associated with a decreased food intake or reduced metabolic activity in the pregnant women. This state of leptin resistance is comparable to the condition in obesity. In contrast, hypoleptinaemia is suggested to be an indicator for the cessation of pregnancy, either naturally at term or as a result of pathology at any time during gestation. Thus, an appropriate maternal leptin level seems to be a prerequisite for a normal pregnancy. The main source of foetal leptin is the still immature foetal adipose tissue. As intrauterine growth has been found to be independently associated with cord blood leptin level, it has been suggested that leptin plays a role as a regulator of foetal growth. During assisted reproduction cycles leptin levels in the follicular fluid of patients may be also of predictive value, with low levels predicting therapeutic failure. Finally, the relevance of leptin to postnatal development is reviewed; leptin may be important for regulation of satiety and peripheral metabolism. In summary, leptin appears to be an important permissive factor that is involved in female reproduction.

Relationship Between Ovarian Stimulation Regimen and Cytokine Concentration in Follicular Fluid and Their Effect on Fertilization and Pregnancy Outcome of Patients Undergoing ICSI Program

The aims of this study were to evaluate the presence of insulin-like growth factor (IGF)-I, platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) in pre-ovulatory follicular fluid (FF) in patients undergoing ovarian hyperstimulation for intra-cytoplasmic sperm injection (ICSI) treatment, to determine the differences between the concentrations of these cytokines in relation to ovarian stimulation regimens, and to find the relationship between these parameters and estradiol 17-beta, progesterone, and luteinizing hormone (LH) concentration in serum, as well as ICSI outcome. IGF-I and PDGF were measured in the FF of 85 patients. The IGF-I levels were measured by radioimmunoassay, whereas the concentrations of PDGF and EGF were measured by enzyme-linked immunosorbent assay technique, using commercially available kits. IGF-I (0.42 +/- 0.09 ng/mL), PDGF (307.3 +/- 274.5 pg/mL), and EDF (8.88 +/- 6.4 pg/mL) were present in pre-ovulatory FF in patients undergoing ovarian hyperstimulation for ICSI treatment. The mean concentration of IGF-I in the follicle-stimulating hormone (FSH) group was significantly higher (P = 0.036) than that found in the human menopausal gonadotrophin (hMG)/FSH group, whereas no significant difference in the mean concentrations of PDGF (P = 0.58) and EGF was shown between all investigated groups. Controlled ovarian stimulation regimens affect only IGF-I levels in FF and the cytokine concentrations of all investigated groups, in turn, showed no correlation either with steroid hormones in serum or ICSI outcome.

P-124. Afamin and vitamin E in follicular fluid of patients undergoing IVF

P-124. Afamin and vitamin E in follicular fluid of patients undergoing IVF

The pathogenesis of ovarian hyperstimulation syndrome: in vivo studies investigating the role of interleukin-1β, interleukin-6, and vascular endothelial growth factor

Objective: To evaluate systemic and ovarian changes in levels of interleukin (IL)-1β, IL-6, and vascular endothelial growth factor (VEGF) in response to hCG administration to determine which may be the potential initiator of vascular effects and to identify the main source of the substance; to evaluate serum and follicular fluid levels of these cytokines as markers of ovarian hyperstimulation syndrome (OHSS), and to compare levels of these cytokines under basal conditions in women with normal ovulation and those with polycystic ovary syndrome (PCOS). Design: Prospective controlled study. Setting: In vitro fertilization program at the Instituto Valenciano de Infertilidad, Valencia, Spain. Patient(s): Women undergoing IVF, in whom the first two study objectives were analyzed, and women with normal ovulation and patients with PCOS undergoing retrieval of immature oocytes in natural cycles or cycles stimulated for IUI but cancelled during induction of ovulation, in whom the third study objective was analyzed. Intervention(s): Serum was collected before and after hCG administration, and follicular fluid was collected at ovum pick-up. Main Outcome Measure(s): Serum and follicular fluid levels of IL-1β, IL-6, and VEGF. Result(s): There was a significant increase in serum VEGF levels after hCG administration in patients who were at risk for OHSS compared with those who were not at risk for OHSS. Significantly lower VEGF levels were found in the follicular fluid of patients who were at risk; this decrease was the only useful marker to discriminate between the two groups. Moreover, both groups had similar cytokine production under basal conditions. An increase in serum E 2 occurred coincident with a decrease in IL-1β, IL-6, and VEGF in patients with PCOS. Conclusion(s): Vascular endothelial growth factor seems to be the mediator of hCG on the vascular tree. There was an early systemic increase in VEGF that may have significance in the development of OHSS. A decrease in the follicular fluid VEGF concentration is a valid marker to identify women in whom OHSS will develop. The pattern of cytokine release in patients with PCOS under basal conditions was not different from that in women with normal ovulation.

Propofol concentrations in follicular fluid during general anaesthesia for transvaginal oocyte retrieval.

Propofol (Diprivan) is an i.v. anaesthetic used for general anaesthesia. The purpose of this study was to measure the propofol concentration in arterial blood and follicular fluid in patients during transvaginal oocyte retrieval. After approval by the University Ethics Committee, 30 women participated in this prospective study. Following induction of anaesthesia with 0.5 mg alfentanil and 2 mg.kg-1 propofol i.v., a continuous infusion of propofol at 10 mg.kg-1.h-1 was used for maintenance of anaesthesia. Follicular fluid and arterial blood samples were aspirated simultaneously at fixed intervals during the surgical procedure and propofol assayed by high pressure liquid chromatography (HPLC). The mean follicular fluid concentration of propofol increased linearly with time from 0.10 +/- 0.02 microgram.ml-1 to 0.57 +/- 0.06 microgram.ml-1 and was strongly related to the cumulative dose of propofol administered. The absorption of propofol was time-dependent. There was no correlation between the concentration of propofol in the follicular fluid and the arterial blood concentration of the drug. In conclusion, a propofol-based anaesthetic technique resulted in significant concentrations of this agent in follicular fluid, related to the dose administered and to the duration of propofol administration.

The follicular and endocrine environment in women with endometriosis: local and systemic cytokine production

Objective: To assess the endocrine, paracrine, and autocrine milieu in patients with endometriosis on the basis of the measurement of several cytokines in serum and follicular fluid (FF) and in vitro culture of granulosa luteal cells. Design: Case-control study. Setting: In vitro fertilization program at the Instituto Valenciano de Infertilidad. Patient(s): Twenty patients with laparoscopically documented endometriosis and 18 controls. Fifteen subjects were studied in a natural cycle and 23 were investigated in a stimulated cycle while undergoing IVF. Intervention(s): Individual follicle aspiration, oocyte isolation, FF storage, and preparation of luteinized granulosa cell cultures. Diagnostic laparoscopy in natural cycles. Main Outcome Measure(s): Serum (day of ovum pick-up or laparoscopy) and FF measurement of interleukin (IL)-1β, IL-6, and vascular endothelial growth factor (VEGF). Secretion of IL-1β, IL-6, and VEGF in the cell-conditioned medium. Results were compared between patients with endometriosis and controls. Result(s): Interleukin-6 levels in serum were increased in the natural cycles of patients with endometriosis and modulated by ovarian stimulation, showing a significant decrease in hMG- and FSH-stimulated cycles and a significant increase after hCG administration. In addition, IL-6 levels were increased in the FF of patients with endometriosis and released in higher amounts by their granulosa luteal cells. Vascular endothelial growth factor was accumulated in lesser concentrations in the FF of patients with endometriosis. Interleukin-1β levels did not show significant changes. Implantation rates were decreased significantly in patients with endometriosis who were undergoing IVF. Conclusion(s): The data demonstrate that cytokines are regulated differently in patients with endometriosis, who have increased IL-6 production, and suggest that fine hormonal modulation of this cytokine occurs at the systemic and local (ovarian) levels. These changes show that the endocrine, paracrine, and autocrine milieu is different in patients with endometriosis and may be related to their lower implantation rates.

Peri-ovarian adhesions interfere with the diffusion of gonadotrophin into the follicular fluid.

In previous studies, patients with severe peri-ovarian adhesions have been found to show low pregnancy rates and a poor response to gonadotrophin stimulation during in-vitro fertilization (IVF) treatment. The purpose of this retrospective pharmacokinetic study was to assess the diffusion of exogenous human chorionic gonadotrophin (HCG) in patients with peri-ovarian adhesions by examining the concentration of exogenous HCG in the follicular fluid in patients undergoing down-regulation and IVF due to infertility. The patients underwent laparoscopic examination for the scoring of peri-ovarian adhesions (using the classification of adnexal adhesions adopted by the American Fertility Society, a score of 0 means no adhesions, and a score of 32 represents bilateral expanded dense adhesions). Oocytes were recovered after human menopausal gonadotrophin-human chorionic gonadotrophin (HMG-HCG) stimulation with gonadotrophin-releasing hormone agonist. Serum and follicular fluid were collected at the time of oocyte recovery for measuring the HCG ratio (the follicular HCG concentration to the serum HCG concentration; a reflection of the diffusion of exogenous gonadotrophin) by time-resolved fluoroimmunoassay. A negative correlation was found between the number of oocytes recovered and the peri-ovarian adhesion score (r = -0.62, P < 0.01). In a given patient, the follicular HCG concentration was always lower than the serum HCG at the time of oocyte recovery. The HCG ratio in all samples was 0.9 or less (0.51 +/- 0.20; range, 0.09-0.90). Significant negative correlations were found between the peri-ovarian adhesion score and both the follicular HCG concentration (r = -0.80, P < 0.01) and the HCG ratio (r = -0.75, P < 0.01). In conclusion, severe peri-ovarian adhesions interfered with the diffusion of exogenous gonadotrophin into the follicular fluid during IVF treatment. Thus, the diffusion of exogenous gonadotrophin into the follicular fluid may represent a new parameter in the assessment of ovarian blood flow and IVF outcome.

The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a dramatic complication of ovulation induction. In its most severe form, OHSS is characterized by massive cystic enlargement of the ovaries associated with third space fluid shift, resulting in the formation of ascites and pleural effusion. Ascites developes because of increased peritoneal capillary permeability. In this study we examined the role of vascular endothelial growth factor (VEGF) and interleukins in the pathogenesis of increased capillary permeability. VEGF is a member of the family of heparin binding proteins that act directly on endothelial cells to induce proliferation and angiogenesis. VEGF mRNA and protein are expressed by human ovarian granulosa and theca cells late in follicular development and subsequent to ovulation by granulosa and theca cells. Therefore, VEGF is ideally positioned to provoke the increased permeability of theca blood vessels that occurs shortly before ovulation. Hybridization studies in the rat and primate ovary have demonstrated VEGF mRNA expression predominantly after the luteinizing hormone (LH) surge known to be essential for OHSS. The gonadotrophin-releasing hormone antagonist results in a decreased mRNA expression, implying such expression is dependent on LH. The expression of VEGF mRNA has been recently shown to be enhanced by human chorionic gonadotrophin (HCG) in a dose- and time-dependent fashion. These studies confirm the timely association between VEGF and HCG that has been clinically known for many years to be integral in the development of OHSS. VEGF concentrations in serum, peritoneal fluid and follicular fluid of patients at risk for OHSS have been shown to be significantly related to the development of the syndrome. Furthermore, the kinetics of VEGF in the plasma of patients who actually develop severe OHSS are closely correlated with the clinical course of the syndrome and with certain biological characteristics of OHSS and of capillary leakage, such as leukocytosis and increased hematocrit. Studies on ascitic fluid from patients with sever OHSS have proved that VEGF is the major capillary permeability agent. Incubation with VEGF antiserum decreased the vascular permeability activity by 70%. Interleukin-2 (IL-2) is the first of a series of lymphocytotrophic hormones to be recognized as pivotal for the regulation of immune response. However, hard data to confirm its central role in the pathogenesis of OHSS are still lacking, despite the fact that some preliminary studies suggest a positive association between the pooled follicular fluid IL-2 concentration and the development of OHSS. IL-6 is a mediator of the acute phase response to injury, a systemic reaction characterized by leukocytosis, increased vascular permeability and increased synthesis of acute phase proteins by the liver. Significantly higher serum and ascites IL-6 concentrations were seen in OHSS patients. The immunohistochemical localization pattern suggested that IL-6 is LH or HCG dependent. However, the use of IL-6 as a predictor for the occurrence of OHSS has not been successful. The kinetics of IL-6 in patients with severe OHSS are correlated with the clinical symptoms and the biochemical parameters known to be associated with the severity of the syndrome, suggesting a possible role for IL-6. Further molecular biology studies similar to those performed on VEGF are needed to confirm if this interleukin is central in the cascade of events. IL-8 is a chemoattractant, activating cytokine and a potent angiogenic agent. The peritoneal fluid levels is increased in patients with severe OHSS; its concentration in peritoneal fluid is increased inpatients with severe OHSS. The place of this interleukin in the cascade of events is as yet undetermined and further studies are needed. In conclusion, molecular biology and clinical studies strongly suggest that VEGF is the principal mediator by which HCG might increase capillary permeability in OHSS.

Flow cytometric evaluation of leukocyte subpopulations in the follicular fluids of infertile patients

To evaluate the leukocyte subpopulations present in follicular fluid (FF) of infertile patients undergoing IVF-ET for tubal factor, idiopathic infertility, and endometriosis. Sixty patients undergoing IVF-ET with a tubal factor diagnosis (n = 35), idiopathic infertility (n = 13), and endometriosis (n = 12) had their subpopulations of FF leukocytes analyzed by flow cytometry. Nonblood-contaminated samples of FF were collected under sterile conditions and centrifuged. Cells were labeled with a panel of monoclonal antibodies: anti-CD3, -CD4, -CD8, -CD14, -CD20, -CD45, and -CD56, and analyzed by cytofluorometry. Follicular fluid leukocytes from patients with idiopathic infertility had a significantly higher proportion of T lymphocytes than tubal factor and endometriosis patients. Endometriosis patients had significantly higher proportions of natural killer (NK) cells, B lymphocytes, and monocytes compared with groups of idiopathic infertility and tubal factor. The differences observed in the leukocyte subpopulations from FF of patients with idiopathic infertility and endometriosis may affect folliculogenesis and oocyte maturation. Moreover, these modifications could be one of the factors altering their fertility.