| Ovarian hyperstimulation syndrome(OHSS) is a common complication in assisted reproductive technology. The severe clinical manifestations that may accompany the syndrome include a state of hypercoagulability, thromboembolic phenomena, viscera function damage, and even death. The etiology of OHSS is complex and many aspects remain unclear, and no specific therapy or prevention is available. Therefore probing into the pathogenesis, searching for the high risk factors, researching a safe and non-toxic medicine is the urgent need which the OHSS patients.1. Ovarian hyperstimulation syndrome clinical analysis of the related factorsObjective:To investigate the correlate factors and therapy strategy of ovarian hyperstimulation syndrome (OHSS) with different severity.Methods:We analyze retrospectively patients who hospitalized for OHSS in ovulation induction from January2010to December2012, compare the clinical data, the situation of stimulate ovulation and embryo transfer of mild, moderate and severe OHSS.Results:1. In nearly three years, there were73patients occurred OHSS in3313cycles, the total incidence was2.2%, among which,0.81% was mild OHSS,0.99%was moderate OHSS, the incidence od severe OHSS was0.39%.2. The hospitalization time and variation of abdominal girth and weight of severe OHSS were significantly more than the which of mild OHSS (P<0.05). There was no statistical difference between the severity and infertility reason (P=0.143), but the rate of PCOS patients with severe OHSS was apparently higher than that of mild, moderate OHSS (P<0.05). Based on attact time, early OHSS occurred with severe OHSS had higher incidence rate than did in late OHSS, the late OHSS was more prone to occur mild and moderate OHSS. The occurrence of moderate and severe OHSS was relavant to the attact time (X2=14.2, P<0.05).3. The growth of ovarian diameter, small and medium sized follicles and serum E2levels on the day of HCG administration of moderate and severe OHSS were significantly higher compared with that of mild OHSS after controlled ovarian hyperstimulation(P<0.05). But there were no significant differences in the amount of basal antral follicles and collected eggs in three groups.4.19patients were cancelled transplantation in73OHSS, the total cancellation rate was26.03%. There were no significant differences in fertilization methods, good embryo rate and optimal embryo number in groups (P>0.05). The incidence rate of severe OHSS in pregnant womon was obviously higher than that of non-pregnancy (P<0.05).Conclusion:PCOS history, a large number of small and medium sized follicles, high level of resum E2on the day of HCG administration and pregnancy were high risk factors to induce OHSS, which could predict OHSS and judge the severity. Judicious treatments probably would effectively prevent and reduce OHSS.2. The Experimental Study of Curcumin on Protection in a Rat of Ovarian Hyperstimulation SyndromeObjective:The aim of this study was to investigate the effect of different concentrations of curcumin on serum estradiol, renin-angiotensin system (RAS) and ovarian vascular endothelial growth factor (VEGF) and its receptors in a rat model of ovarian hyperstimulation (OHSS), to explore the effect of curcumin on preventing OHSS and the action mechanism of curcumin on decresing vascular permeability.Methods:A total of63female Sprague-Dawley (SD) rats aged22days were randomly divided into seven groups:six groups were intragastrically administered curcumin (0,10,25,50,100and250mg/kg), control group was intragastrically administered vehicle alone for seven days. Meanwhile except of control group all rats were given10IU of pregnant mare serum gonadotropin (PMSG) for4consecutive days and given100IU of human chorionic gonadotropin (HCG) on fifth day to form OHSS model. The ovarian tissue morphology of rats was observed, the levels of peritoneal extravasated Evans Blue(EB) and serum estradiol (E2) were measured. The expressions of renin and AngⅡ in serum and ovarian VEGF and its receptors, including VEGFR-1and VEGFR-2, were detected by enzyme-linked immune sorbent assay (ELISA) after48h following an injection of HCG. The expression of VEGFR-2was further tested by Western blotting.Results:1. With the naked eye, the growth of the ovaries volume was found to have increased significantly after establishment of the OHSS model, the average ovarian weight in the Omg/kg group was increased nearly10-fold compared with the control group. Microscopic examination:multiple cystic ovaries with luteal or hemorrhagic cysts were found in all rats of the model groups, obvious ovaries enlargement with cystic regular morphology and interstitial edema. After the treatment of curcumin, the weight of ovaries was reducted, the diamond of luteal was shorted and the severity of interstitial edema was lessened compared with the Omg/kg group, one of the most remarkable was the50mg/kg Cur group.2. The level of the recovered fluid and EB of the peritoneal cavity and the rate of the weight gain showed significantly differences between the control group and the Omg/kg group (P<0.05). After the treatment of curcumin, administration of50mg/kg of curcumin reduced furthest the increments of the three levels. The rate of the weight gain and the level of the recovered fluid were both proportional to the vascular permeability.3. Serum estradiol concentration and the levels of renin and AngⅡ in the Omg/kg group were significantly increased compared with the control group (P<0.01). After the treatment of curcumin, the content of E2and AngⅡ was lowest at the concentration of50mg/kg, while the effect of curcumin on renin was not significant.The levels of estradiol and RAS in serum had a significant linear correlation with the ovarian weight and the level of the recovered fluid.4. After the establishment of OHSS model, the levels of VEGF, VEGFR-1, and VEGFR-2were all increased compared with the control group, but there was no significantly difference on VEGFR-1concentration between the Omg/kg group and the control group (P>0.05). After the treatment of curcumin, the three levels were all decreased, the expressions of VEGF and VEGFR-2were reduced in great degree after the intervation of50mg/kg curcumin, there were significant difference compared with the Omg/kg group (P<0.01). While there was no significantly difference on the level of VEGFR-1compared with the Omg/kg group (P>0.05). The expression of VEGFR-2was showed a similar trend by western blot and ELISA (Omg/kg group>curcumin groups> control group).Conclusion:1. The two roles of curcumin for estradiol were contradictory: inhibiting E2and estrogenic effect. Curcumin at50mg/kg concentration showed the best effect on inhibiting E2level of OHSS to a greatest extent, and the estrogenic activity was also weakest.2. There were some relationship between RAS system and OHSS, curcumin could inhibit the activity of RAS system though reduing the content of AngⅡ, there were differences of biological activity between different concentrations of curcumin.3. VEGF and VEGFR-2were identified as crucial for the occurrence of OHSS. Curcumin could have two opposing effects on vascular permeability which both to increase and to inhibit, the50mg/kg dose curcumin showed strongest inhibition of VEGF and VEGFR-2. |
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