Dynamic changes of the immunoglobulins in patients with severe ovarian hyperstimulation syndrome: efficacy of a novel treatment using peritoneo-venous shunt.
OBJECTIVE
To evaluate the efficacy of continuous auto-transfusion system of ascites (CATSA) for the treatment of patients with severe ovarian hyperstimulation syndrome (OHSS) at the risk of febrile morbidity, the dynamic changes of immunoglobulins in the sera and the peritoneal fluid from patients with severe OHSS treated by CATSA were estimated.


METHODS
Ten patients with severe OHSS after superovulation for in vitro fertilization-embryo transfer (IVF-ET) were treated by CATSA. Immunoglobulin concentrations were examined in the serum and in the peritoneal fluid before and after CATSA. As controls, serum samples from 15 infertile women, who did not develop OHSS after the same superovulation protocol, were obtained on the day of mid-luteal period (Control-1). Serum samples from 15 patients with OHSS, who were treated by albumin infusion without paracentesis, were also obtained before and after the treatment (Control-2).


RESULTS
Before the treatments, serum immunoglobulin G (IgG) concentrations in patients with severe OHSS treated with CATSA and those in patients of Control-2 were significantly lower than those in patients of Control-1 (P < 0.01). Following CATSA, the concentration of IgG increased in the sera, while it decreased in the peritoneal fluid.


CONCLUSIONS
Serum IgG in patients with severe OHSS exuded into their peritoneal cavity, indicating that they might be at the status of immunodeficiency and at the risk of febrile morbidity. However, non-infectious febrile morbidity attributed to endogenous pyrogenic mechanism might be considerable. It is also suggested that CATSA might be effective in improving hypoimmunoglobulinemia of the patients with severe OHSS by the peritoneo-venous shunt.
Takamizawa
Satoru
S
Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan.
Shibahara
Hiroaki
H
Taneichi
Akiyo
A
Obara
Hiromi
H
Fujiwara
Hiroyuki
H
Ogawa
Syuichi
S
Koike
Toshimitsu
T
Idei
Sadayoshi
S
Sato
Ikuo
I
D000328:Adult; D000418:Albumins / Q000627:therapeutic use; D001201:Ascites / Q000276:immunology / Q000601:surgery; D001202:Ascitic Fluid / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D017099:IgG Deficiency / Q000209:etiology / Q000276:immunology / Q000601:surgery; D007074:Immunoglobulin G / Q000097:blood* / Q000378:metabolism; D007247:Infertility, Female / Q000628:therapy; D016471:Ovarian Hyperstimulation Syndrome / Q000276:immunology* / Q000601:surgery*; D010062:Ovulation Induction / Q000009:adverse effects; D010536:Peritoneovenous Shunt; D011247:Pregnancy
D000418:Albumins; D007074:Immunoglobulin G; D002097:C-Reactive Protein