Effect Of The Dual Suppression On Follicular Fluid Vascular Endothelial Growth Factor Concentration In Patients With Polycystic Ovarian Syndrome Undergoing Controlled Ovarian Hyperstimulation

Objective: The aim of this study was to investigate the effect of the dual suppression with oral contraceptive (OC) in combination with gonadotrophin releasing hormone agonist (GnRH-a) on follicular fluid (FF) vascular endothelial growth factor (VEGF) concentration in patients with polycystic ovarian syndrome (PCOS) undergoing controlled ovarian hyperstimulation (COH). Method: Patients with PCOS as the OC+GnRH-a group and patients with male factor, tubal factor, mixed factor and endometriosis as a control group were enrolled prospectively from in vitro fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) program at the reproductive endocrinology department of Woman's Hospital School of Medicine Zhejiang University. OC pills were taken for 18 days in the OC+GnRH-a group followed by GnRH-a, which was overlapped with the final day of OC administration. All patients underwent a long-protocol regimen. Same dose gonadotrophin (Gn) stimulation is then initiated on the third day of withdrawal bleeding in both groups. FF was collected at the time of oocyte retrieval (OR) from subjects whose serum estradiol (E₂) on the day of hCG administration more than 14680pmol/L. This study included 11 patients in theOC+GnRH-a group and 47 patients in the control group. FF samples were analysedfor VEGF concentrations by enzyme-labeled immunosorbent assay (EL1SA).Occurrences of moderate and severe OHSS were recorded.Results: The FF levels of VEGF in the OC+GnRH-a group at the time of OR werestatistically significantly lower than those from the controls. By contrast, there wereno statistically significant differences between the two groups in duration andcumulative dose of Gn, E₂ levels on the day of hCG administration, the number ofoocytes, the proportion of patents who developed OHSS.Conclution: It is speculated that the dual suppression with OC and GnRH-a mayprevent early OHSS by decreasing FF VEGF levels in patients with PCOSundergoing COH.