Renin-angiotensin system activation during severe OHSS: cause or effect?

Manno, Massimo; Tomei, Francesco

doi:10.1016/j.fertnstert.2007.12.003

Cited by 22 publications

(18 citation statements)

References 6 publications

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“…This novel strategy for use in patients at high risk for OHSS did not completely eliminate the development of the syndrome (24). There are also concerns about the safety of the treatment as angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists have a possible teratogenic effect in humans (25). Nevertheless, this study may suggest that an altered renin-angiotensin system plays a major role in the development of OHSS.…”

Section: Discussionmentioning

confidence: 79%

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Gürgan¹,

Demi̇rol²,

Güven

et al. 2011

Fertility and Sterility

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Section: Discussionmentioning

confidence: 79%

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Gürgan¹,

Demi̇rol²,

Güven

et al. 2011

Fertility and Sterility

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“…Prior researches illustrated that VEGF is the main mediator in the pathogenesis of OHSS [1,2,3,4] . Infertility investigator introduced oral cabergoline as VEGF receptor antagonist [17,18] and calcium infusion [35,36,37,38,39] as VEGF lowering agent, so they targeting VEGF at different points of OHSS pathogenesis cascade and comparing both drugs against placebo as well as versus each other and reporting varying degree of success of both agents. This trial tested the interaction of adding oral cabergoline as VEGF receptor antagonist with calcium infusion as VEGF lowering drug and found a significant lowering effect of this combination on overall OHSS incidence [overall OHSS 87.2%) 110/) in CI+ versus 1816.3%) 110/) in CI-with ∆pp = -9.1% at 95% CI of (-0.49, -17.8), P = 0.036] as well non significant lowering effect on moderate (p = 0.3) and severe (p = 0.3) OHSS.…”

Section: Discussionmentioning

confidence: 99%

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Sharafeldeen

2018

Evidence Based Women's Health Journal

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Aim: To evaluate the interaction of adding oral cabergoline (OC) to calcium infusion as a preventive modality for ovarian hyperstimulation syndrome (OHSS) in risky women undergoing controlled ovarian hyperstimulation (COH) in context of in-vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI). Patients and Methods: This prospective, double-blind, randomized, placebo-controlled trial was conducted at Benha IVF center of Obstetrics and Gynecology Department of Benha University and Nour Al Hayah Fertility Center Between January 2015 and February 2016. 220 risky women for OHSS undergoing ICSI were included, they were randomized to 110 women received once daily OC for eight days, starting at HCG triggering and infusion of calcium gluconate 10 ml 10% in 200 ml 0.9% saline daily for 4 days beginning at ovum pick up (OPU), coined as calcium infusion plus group (CI+) and 110 women received only calcium infusion in the same fashion as in CI+ coined as calcium infusion minus group (CI-). The primary outcome was the overall incidence of OHSS while the secondary issues were OHSS types and grades as well as other ICSI outcomes. Results: The incidence of overall OHSS was significantly lower in calcium infusion plus oral cabergoline (CI+) group compared to calcium infusion alone (CI-) group [8/110(7.2%) in CI+ versus 18/110 (16.3%) in CI-with difference in proportion percentage point (∆PP)=-9.1%, 95% CI: -0.49, -17.4; P = 0.036]. Despite the incidence of moderate and severe OHSS was lower in CI+ than in CI-, this difference didn't reach the significance level (2.7% vs 5.4%; p = 0.3) and (0.9% versus 2.7%; ), respectively. The other COH and ICSI outcomes didn't show any statistically significant differences. Conclusion: Adding oral cabergoline to calcium infusion is effective than calcium infusion alone in the reduction of overall OHSS incidence as well as its severity at comparable pregnancy outcomes.

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“…Estradiol level is a reliable predictor of OHSS during ART [5] OHSS can occur despite low estradiol levels [10] High estradiol concentrations are not sufficient to induce OHSS [6] Currently considered a mere marker of granulose activity [11] There is a direct correlation between plasma renin activity and the severity of OHSS [13] All hypovolemic conditions are associated with a secondary reactive hyperaldosteronism via renin-angiotensin cascade activation [17] Renin-angiotensin system activation is probably the effect and not the cause of OHSS VEGF VEGF expression is associated with OHSS increased vascular permeability [18] VEGF levels are elevated during ovarian stimulation with exogenous FSH, which is enhanced after hCG administration [19,20] plasma angiotensin-converting enzyme was reported in a case of severe OHSS [16]. However, renin-angiotensin system activation is probably an effect of and not the cause of OHSS.…”

Section: Estradiolmentioning

confidence: 99%

“…However, renin-angiotensin system activation is probably an effect of and not the cause of OHSS. All hypovolemic conditions are associated with a secondary reactive hyperaldosteronism by reninangiotensin cascade activation [17].…”

Section: Estradiolmentioning

confidence: 99%

“…In both studies, the embryos were cryopreserved and transferred in subsequent cycles. However, the activation of renin-angiotensin system is probably the effect and not the cause of OHSS, and one should be cautious when considering this strategy, since there are harmful effects to the fetuses and the possibility of worsening OHSS associated renal failure [17].…”

Section: Albumin Administrationmentioning

confidence: 99%

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Ovarian hyperstimulation syndrome: pathophysiology and prevention

Nastri

Ferriani

Rocha

et al. 2010

J Assist Reprod Genet

194

157

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Purpose To review and discuss the pathophysiology and prevention strategies for ovarian hyperstimulation syndrome (OHSS), which is a condition that may occur in up to 20% of the high risk women submitted to assisted reproductive technology cycles. Methods The English language literature on these topics were reviewed through PubMed and discussed with emphasis on recent data. Results The role of estradiol, luteinizing hormone, human chorionic gonadotropin (hCG), inflammatory mediators, the renin-angiotensin system and vascular endothelial growth factor is discussed in the pathophysiology of OHSS. In addition we consider the prevention strategies, including coasting, administration of albumin, renin-angiotensin system blockage, dopamine agonist administration, nonsteroidal anti-inflammatory administration, GnRH antagonist protocols, reducing hCG dosage, replacement of hCG and in vitro maturation of oocytes (IVM). Conclusions Among the many prevention strategies that have been discussed, the current evidence points to the replacement of hCG by GnRH agonists in antagonist cycles and the performance of IVM procedures as the safest approaches.

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Renin-angiotensin system activation during severe OHSS: cause or effect?

Cited by 22 publications

References 6 publications

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Ovarian hyperstimulation syndrome: pathophysiology and prevention

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