Pau Elena, Alonso-Muriel Isabel, Gómez Raul, Novella Edurne, Ruiz Amparo, García-Velasco Juan A, Simón Carlos, Pellicer Antonio
Instituto Valenciano de Infertilidad Foundation, University of Valencia, Valencia, Spain.
Hum Reprod. 2006 Jun;21(6):1453-60. doi: 10.1093/humrep/del005. Epub 2006 Feb 17.
Ovarian hyperstimulation syndrome (OHSS) is a life-threatening condition associated with ovarian stimulation. Its pathophysiology is unknown and its treatment continues to be empirical. Early (E)- and late (L)-OHSS occur in women at risk, though not in all cases. Vascular endothelial growth factor (VEGF) is related to increased vascular permeability in OHSS. We analysed the dynamics of the VEGF system in E- and L-OHSS.
A prospective cohort of women undergoing IVF-ICSI treatment were divided into groups. E-OHSS: Nonpregnant patients classified as women not at risk (group 1) (n = 11) and patients at risk who did not (group 2) (n = 18) and did (group 3) (n = 8) develop severe OHSS. Blood was drawn on the day of ovum retrieval (day 0) and 3, 6, 10 and 14 days later. L-OHSS: Single pregnancies classified as women who did not (group 4) (n = 8) and did develop (group 5) (n = 4) OHSS. Single pregnancies after oocyte donation (OD) (n = 4) were compared with groups 4 and 5 (IVF-ICSI). Blood was obtained weekly (weeks 4-12). Total VEGF (VEFG-A), free (f)-VEGF and soluble VEGF receptor 1 (sVEGFR-1) in plasma and in serum alpha2-macroglobulin (M) were also measured.
Group 3 showed significantly (P < 0.05) higher VEFG-A and f-VEGF than group 1 on day 6 because of lower sVEGFR-1 secretion. Similarly, group 5 had significantly (P < 0.05) more VEFG-A and f-VEGF and less sVEGFR-1 than group 4. Oocyte donation was associated with decreased sVEGFR-1 secretion, and alpha2M was not relevant in OHSS development.
In E- and L-OHSS, the ability to secrete sVEGFR-1 and bind VEGF seems to be the determinant factor in OHSS. f-VEGF acts locally in the ovary.
卵巢过度刺激综合征（OHSS）是一种与卵巢刺激相关的危及生命的疾病。其病理生理学尚不清楚，治疗仍为经验性的。早期（E）-OHSS和晚期（L）-OHSS发生于有风险的女性，但并非所有病例都会出现。血管内皮生长因子（VEGF）与OHSS中血管通透性增加有关。我们分析了E-OHSS和L-OHSS中VEGF系统的动态变化。
将接受体外受精-卵胞浆内单精子注射（IVF-ICSI）治疗的女性前瞻性队列分为几组。E-OHSS：未怀孕患者分为非风险女性组（第1组）（n = 11）、有风险但未发生（第2组）（n = 18）和发生（第3组）（n = 8）严重OHSS的患者。在取卵日（第0天）及之后的第3、6、10和14天采血。L-OHSS：单胎妊娠分为未发生（第4组）（n = 8）和发生（第5组）（n = 4）OHSS的女性。将卵母细胞捐赠（OD）后的单胎妊娠（n = 4）与第4组和第5组（IVF-ICSI）进行比较。每周（第4 - 12周）采血。还测量了血浆和血清α2-巨球蛋白（M）中的总VEGF（VEFG-A）、游离（f）-VEGF和可溶性VEGF受体1（sVEGFR-1）。
由于sVEGFR-1分泌较低第3组在第6天的VEFG-A和f-VEGF显著高于第1组（P < 0.05）。同样，第5组的VEFG-A和f-VEGF显著多于第4组（P < 0.05），而sVEGFR-1则较少。卵母细胞捐赠与sVEGFR-1分泌减少有关，且α2M与OHSS的发生无关。
在E-OHSS和L-OHSS中，分泌sVEGFR-1和结合VEGF的能力似乎是OHSS的决定性因素。f-VEGF在卵巢局部起作用。
