Systematic review of data concerning etiopathology of ovarian hyperstimulation syndrome.
The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation occurring during the luteal phase or early pregnancy. It has been observed over the last 60 years, since gonadotropins were first used to induce ovulation. The prevalence varies, according to study, from 0.5% to 5%. The pathogenesis of OHSS is, apparently, complex. It involves a vasoactive mediator, secreted by the ovaries (in overabundance) after artificial stimulation. Estradiol, which is a marker of ovarian response, is not the mediator. The candidate mediators reviewed are prolactin and prostaglandins; the ovarian prorenin-renin-angiotensin system; cytokines (including allergy-cytokines-histamine as a system); VEGF; angiogenin; the Kinin-Kallikrein system; VCAM and ICAM; selectins; von Willebrand factor; and endothelin. The main conclusion is that OHSS is the result of disturbance of the basically inflammation-like normal ovulation process, and has as its main feature capillary leakage and transmission of mediators to other compartments.
Delvigne
Annick
A
IVF Centre, Department of Obstetrics-Gynaecology, University Hospital St Pierre (Free University of Brussels-ULB), Brussels, Belgium.
Rozenberg
Serge
S
D001160:Arterioles / Q000503:physiopathology; D016207:Cytokines / Q000378:metabolism; D019040:E-Selectin / Q000378:metabolism; D016228:Endothelial Growth Factors / Q000378:metabolism; D019332:Endothelin-1 / Q000378:metabolism; D004792:Enzyme Precursors / Q000378:metabolism; D004967:Estrogens / Q000378:metabolism; D005260:Female; D006632:Histamine / Q000378:metabolism; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism; D007610:Kallikreins / Q000378:metabolism; D007705:Kinins / Q000378:metabolism; D008222:Lymphokines / Q000378:metabolism; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011388:Prolactin / Q000378:metabolism; D011453:Prostaglandins / Q000378:metabolism; D012083:Renin / Q000378:metabolism; D012084:Renin-Angiotensin System; D012307:Risk Factors; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D014664:Vasodilation; D014841:von Willebrand Factor / Q000378:metabolism
D016207:Cytokines; D019040:E-Selectin; D016228:Endothelial Growth Factors; D019332:Endothelin-1; D004792:Enzyme Precursors; D004967:Estrogens; D036341:Intercellular Signaling Peptides and Proteins; D007705:Kinins; D008222:Lymphokines; D011453:Prostaglandins; D019010:Vascular Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1; D006632:Histamine; D011388:Prolactin; D007610:Kallikreins; D012083:Renin