» Articles » PMID: 18385260

Targeting the Vascular Endothelial Growth Factor System to Prevent Ovarian Hyperstimulation Syndrome

Overview
Date 2008 Apr 4
PMID 18385260
Citations 66
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Ovarian hyperstimulation syndrome (OHSS) typically occurs when ovaries are primed with FSH/LH and subsequently exposed to hCG. The ultimate pathophysiological step underlying this clinical picture is increased vascular permeability (VP).

Methods: A search of the literature was carried out using PubMed and the authors' files.

Results: In rodents and humans, the expression of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) mRNA increases during ovarian stimulation. With the administration of hCG, the expression of each rises to a maximum. Expression of VEGF/VEGFR-2 mRNAs correlates with enhanced VP, with both peaking 48 h following an injection of hCG. Immunohistochemistry shows the presence of VEGF and VEGFR-2 proteins in the granulosa-lutein and endothelial cells of the entire corpus luteum. Increased VP may be mediated through adhesion molecules such as VE-cadherin, which is involved in the loosening of endothelial intercellular junctions. These findings regarding the pathophysiology of OHSS suggest that the syndrome can be prevented by inducing ovulation with LH or GnRH analogues, which prevent VEGF overexpression. Also, co-administration of a dopamine agonist inhibits phosphorylation of the receptor VEGFR-2. In a trial of 69 oocyte donors, the incidence of moderate OHSS was 20% with the dopamine agonist cabergoline and 44% with a placebo (P = 0.04).

Conclusions: The pathophysiological mechanisms involved in OHSS suggest potential preventive approaches, but larger trials are necessary for evaluating the efficacy and safety of the pharmaco-prevention of OHSS.

Citing Articles

GnRH agonist-only trigger, compared to dual trigger, reduces oocyte retrieval rate in high responders without affecting cumulative live birth rate.

Wang Y, Yi Y, Guu H, Chen Y, Kung H, Chang J Front Endocrinol (Lausanne). 2024; 15:1461317.

PMID: 39229374 PMC: 11368714. DOI: 10.3389/fendo.2024.1461317.


A Comprehensive Review of the Efficacy and Safety of Dopamine Agonists for Women with Endometriosis-associated Infertility from Inception to July 31, 2022.

Estole-Casanova L Acta Med Philipp. 2024; 58(10):49-64.

PMID: 38939420 PMC: 11199371. DOI: 10.47895/amp.vi0.6994.


Change of HeART: Cardiovascular Implications of Assisted Reproductive Technology.

Niazi E, Dumanski S CJC Open. 2024; 6(2Part B):142-152.

PMID: 38487072 PMC: 10935705. DOI: 10.1016/j.cjco.2023.09.008.


Efficacy of Soft Extract in Moderate Ovarian Hyperstimulation Syndrome for Concurrent Treatment of Blood and Fluid Guided by the "Triple Prevention" Principle.

Chen Y, Zhang X, Li Z, Wang X, Wang J, Zhang Z Int J Womens Health. 2024; 16:385-394.

PMID: 38463688 PMC: 10924772. DOI: 10.2147/IJWH.S436965.


Preparation and characterization of vaginal suppository of semisynthetic derivatives of ergot alkaloids cabergoline.

Rahmanian-Devin P, Fadaei M, Mashreghi M, Askari V Saudi Pharm J. 2023; 31(12):101849.

PMID: 38028218 PMC: 10663909. DOI: 10.1016/j.jsps.2023.101849.