Dual renin-angiotensin blockade therapy in patients at high risk of early ovarian hyperstimulation syndrome receiving IVF and elective embryo cryopreservation: a case series.
BACKGROUND
Ovarian hyperstimulation syndrome (OHSS) is an important and dangerous aspect of assisted reproduction techniques. Although elective cryopreservation of all embryos can prevent pregnancy-induced late OHSS, it cannot prevent early OHSS, which is induced by hCG administration.


METHODS
We undertook this trial to assess the efficacy with which the combined oral administration of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) could prevent early OHSS in IVF patients at very high risk for this syndrome. Four women, who had serum estradiol concentration > or =8000 pg/ml on the day of hCG injection, were treated with the combination of the ACEI alacepril and the ARB candesartan cilexetil for 8 days starting the day after oocyte retrieval. Embryos were cryopreserved and embryo transfer was postponed until later cycles.


RESULTS
Despite the extremely enlarged ovaries, no ascites was accumulated in any of the cases. Haematocrit (34.1 +/- 1.0) and serum albumin concentration (4.1 +/- 0.2 g/dl) were normal throughout the treatment period. These patients showed elevated plasma renin and angiotensin II concentration before the treatment.


CONCLUSIONS
The dual renin-angiotensin blockade therapy used here would be worth exploring further in a study with more patients and a prospective, randomized design.
Ando
Hisao
H
Department of Obstetrics and Gynecology, Nagoya University School of Medicine, 65, Tsurumai-cho, Showa-ku, Japan. ando@med.nagoya-u.ac.jp
Furugori
Kazunori
K
Shibata
Daijiro
D
Harata
Toko
T
Murata
Yasutaka
Y
Mizutani
Shigehiko
S
D000328:Adult; D000804:Angiotensin II / Q000097:blood; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage; D001713:Biphenyl Compounds / Q000008:administration & dosage; D002216:Captopril / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000009:adverse effects; D015925:Cryopreservation; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D004622:Embryo, Mammalian; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood / Q000517:prevention & control*; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013777:Tetrazoles
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D006063:Chorionic Gonadotropin; D013777:Tetrazoles; D000804:Angiotensin II; D004958:Estradiol; D002216:Captopril; D012083:Renin; C077793:candesartan cilexetil; C046835:alacepril