title: Elevated interleukin-6 levels in the ovarian hyperstimulation syndrome: ovarian immunohistochemical localization of interleukin-6 signal.
abstract: OBJECTIVE
  To examine the production and immunolocalization of interleukin-6 (IL-6) in patients with the ovarian hyperstimulation syndrome.
  
  
  METHODS
  The study group consisted of patients with ovarian hyperstimulation syndrome (n = 9) from whom serum and ascites samples were obtained. The control samples used were serum (n = 10) and peritoneal (n = 16) and follicular fluids (n = 8) from healthy individuals. Follicular fluid (n = 40) and serial serum samples were also obtained from patients undergoing menotropin stimulation for in vitro fertilization (IVF) before (n = 10) and after ovulation (n = 34). Interleukin-6 measurements were performed with a sensitive immunoassay and confirmed with a bioassay. Immunohistochemical localization of IL-6 was performed with a mouse monoclonal antibody in normal premenopausal (n = 5) and postmenopausal ovaries (n = 5), as well as with cells from stimulated follicular fluid aspirates (n = 3).
  
  
  RESULTS
  We found significantly higher serum and ascites IL-6 levels in ovarian hyperstimulation syndrome (mean 18.8 +/- 1.1 and 810.8 +/- 60.7 pg/mL, respectively) compared with postovulatory serum and peritoneal fluid from normal controls (mean 4.4 +/- .69 and 44.7 +/- 7.5 pg/mL, respectively) (P < .001) or serum after menotropin stimulation (13.1 +/- 1.1 pg/mL) (P < .001). At the time of ovulation, follicular fluid IL-6 levels (normal controls, mean 9 +/- 2.1 pg/mL; menotropin stimulation, mean 10.1 +/- 4 pg/mL) were higher than in preovulatory serum (normal controls, mean 4.5 +/- .8 pg/mL; menotropin stimulation, mean 6.3 +/- 1.4 pg/mL) (P < .001). Immunohistochemical localization of IL-6 revealed intense staining in corpora lutea and theca cells from large antral follicles and luteinized granulosa cells in follicular aspirates after menotropin stimulation.
  
  
  CONCLUSIONS
  Interleukin-6 levels are markedly elevated in the ovarian hyperstimulation syndrome when compared with controls. The higher follicular fluid IL-6 levels seen suggest local secretion of this cytokine. Immunohistochemical correlation demonstrated IL-6 within ovarian theca cells. These findings suggest a local role for IL-6 both in normal and stimulated ovarian function. Whether IL-6 is directly responsible for the clinical manifestations of this syndrome is unclear. However, when produced in massive amounts, the pro-inflammatory effects of IL-6 may contribute to its pathogenesis and perhaps serve as a marker for the disease.
authors.affiliation: Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Loret de Mola
authors.forename: J P
authors.initials: JP
authors.lastname: Flores
authors.forename: G P
authors.initials: GP
authors.lastname: Baumgardner
authors.forename: J M
authors.initials: JM
authors.lastname: Goldfarb
authors.forename: V
authors.initials: V
authors.lastname: Gindlesperger
authors.forename: M A
authors.initials: MA
authors.lastname: Friedlander
mesh_terms: D000328:Adult; D000818:Animals; D001202:Ascitic Fluid / Q000737:chemistry; D001681:Biological Assay; D005260:Female; D006801:Humans; D007118:Immunoassay; D007150:Immunohistochemistry; D015850:Interleukin-6 / Q000032:analysis / Q000378:metabolism*; D008596:Menotropins; D051379:Mice; D016471:Ovarian Hyperstimulation Syndrome / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D015850:Interleukin-6; D008596:Menotropins