Elevated levels of CRP in ovarian hyperstimulation syndrome: an unrecognised potential hazard?

Abstract

Objective Elevated levels of C-reactive protein (CRP) were found recently to be a crucial marker for cardiovascular disease. This protein might have a role in endothelial cell activation, vascular damage and a thrombotic tendency. We sought to determine whether concentrations of CRP are altered in women with controlled ovarian hyperstimulation (COH) or hyperstimulation syndrome (OHSS). Design A prospective cohort study.Setting The gynecology department and IVF unit of the Lis maternity hospital.Population Twenty women with OHSS, 20 women undergoing COH and 20 women who participated as controls were included in the study. Methods Venous blood was withdrawn for analysis of high sensitive C-reactive protein (hs-CRP) using the Boering BN-II nephelometer. Main outcome measures hs-CRP levels were determined.Results There was a significant (P < 0.05) difference in the hs-CRP concentrations in women with OHSS compared with women with COH and controls.

C-reactive protein response is higher in early than in late ovarian hyperstimulation syndrome

“…The two to three times higher CRP levels in early OHSS than in the controls, is in line with one earlier study [23]. However, distinguishing early OHSS from infective complications at the emergency polyclinic is difficult.…”

Plasma pentraxin 3 is higher in early ovarian hyperstimulation syndrome than in uncomplicated in vitro fertilization cycle of high-risk women

“…Women in our study were all lean, relatively young and healthy, and their baseline PTX3 levels in the luteal phase of the menstrual cycle were less than 0.5 µg/L. Even during the IVF cycle with multiple ovulations and a stronger inflammatory response than in natural cycle [3,4], the plasma PTX3 level rarely increased above 1.0 µg/L, and in OHSS rarely above 2.0 µg/L. Thus, our findings, indicate that the upper reference limit for P-PTX3 level needs to be re-evaluated in fertile-age women.…”

“…Ovarian hyperstimulation syndrome (OHSS) is the most severe complication of in vitro fertilization (IVF) [1,2] and inflammation, endothelial dysfunction and increased capillary permeability play a profound role in its pathophysiology. The concentrations of several proinflammatory cytokines and C-reactive protein (CRP) are increased in OHSS [3][4][5], but none of them has so far been shown useful in predicting the syndrome. Instead, anti-Müllerian hormone (AMH) and the antral follicle count are the most commonly used tools to predict the risk for OHSS [6][7][8][9].…”

Concentration of soluble urokinase plasminogen activator receptor (suPAR) in the pre-ovulatory follicular fluid is associated with development of ovarian hyperstimulation syndrome during ovarian stimulation

“…In this study, FF CRP levels were not increased among women with severe OHSS compared with controls without moderate-severe OHSS. Several factors related to angiogenesis are believed to be involved in the pathogenesis of OHSS, with VEGF being the most important [17]. VEGF is one of the main regulators of angiogenesis [18] and directly stimulates increased vascular permeability [19].…”