The Correlation Of VEGF And PEDF Levels In Follicular Fluid With OHSS In PCOS Patients

Objective: To explore the correlation of vascular endothelial growth factor(VEGF) and pigment epithelium-derived factor(PEDF) levels in follicular fluid with ovarian hyperstimulation syndrome(OHSS). Methods: A total of 54 PCOS patients undergoing in vitro fertilization- embryo transfer(IVF-ET) treatment were enrolled. 22 cases who showed moderate to severe OHSS were the group A. and 32 cases manifesting mild or no symptom of OHSS were group B. Enzyme-linked immunosorbent assay(ELISA) was used to measure both AMH in serum and VEGF and PEDF level in follicular fluid in each group. Results: The physiology VEGF-PEDF counterbalance was found to be impaired in follicular fluid in patients with OHSS. ① There was a significant difference between the two groups in the mean number of follicles ≥ 14 mm, estradiol(E2) level on HCG day and number of retrieved oocytes. ② The differences of serum AMH, VEGF and VEGF / PEDF Ratio in follicular fluid in two groups were statistically significant. PEDF level in group A was lower than in group B, but there was no statistical significance. ③ In follicular fluid, the VEGF level was negatively correlated with PEDF, and positively correlated with the mean number of follicles ≥ 14 mm on HCG day. VEGF / PEDF Ratio both with the mean number of follicles ≥ 14 mm were positively correlated. ④ The sensitivity and specificity were the highest when VEGF/PEDF ratio was 4.81×10-5 to predict OHSS. Conclusions: These observation provide a new perspective into the pathophysiology of OHSS, namely, high expression level of VEGF together with low level of PEDF. High ratio of VEGF/PEDF in follicular fluid may be a new predictor for OHSS. A replacement therapy with PEDF may be suggested as an innovative physiological treatment for OHSS.