Ovarian hyperstimulation syndrome and assisted reproductive technologies: why some and not others?

Abstract

These results suggest that elevated alpha(2)M levels are associated with a decreased risk of developing OHSS. alpha(2)M may act by 'removing and inactivating' VEGF, with higher levels providing increased protection against the syndrome. alpha(2)M measurements may help to differentiate those for whom it is safe to proceed with embryo transfer from those for whom it is not, because of the risk of OHSS.

Administration of Moderate and High Doses of Gonadotropins to Female Rats Increases Ovarian Vascular Endothelial Growth Factor (VEGF) and VEGF Receptor-2 Expression that Is Associated to Vascular Hyperpermeability1

“…The question that remains is why some women develop OHSS and others do not. The answer is still to be found, but it has recently been suggested how the presence of a binding globulin, ␣ 2 -macroglobulin, in some individuals may account for the availability of VEGF to bind to its KDR receptor [25]. Other components of the VEGF system need to be further investigated, such as the soluble VEGFR (sVEGFR), its natural antagonist.…”

“…Other components of the VEGF system need to be further investigated, such as the soluble VEGFR (sVEGFR), its natural antagonist. Different concentrations of this antagonist have been described in women undergoing IVF [24], suggesting that an increased availability of ␣ 2 -macroglobulin [25] or sVEGFR [26] decreases free VEGF, which explains why some develop OHSS and others do not.…”

Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome

“…High levels of these proteins may decrease free VEGF and protect against OHSS. High follicular fluid concentration of sVEGFR has been reported to be associated with poor ovarian response (Neulen et al, 2001), and high serum concentration of a2M (McElhinney et al, 2002) is thought to be related with a lower risk of developing OHSS.…”

Ovarian hyperstimulation syndrome: Aetiology, prevention and management

“…In addition alpha 2-macroglobulin (a2M), a multi-factorial binding protein, has been found to inhibit VEGF and altered levels may be implicated in the aetiology of the syndrome [16].…”