title: Prolonged HCG action affects angiogenic substances and improves follicular maturation, oocyte quality and fertilization competence in patients with polycystic ovarian syndrome.
abstract: BACKGROUND
  The aim of this study was to determine whether, in polycystic ovarian syndrome (PCOS) patients, HCG action prolonged for 4 h improves the action of angiogenic substances [ovarian renin angiotensin system and vascular endothelial growth factor (VEGF)], and consequently follicular maturation, oocyte quality and oocyte fertilization competence.
  
  
  METHODS
  In this prospective study 20 patients with PCOS undergoing IVF were included. Oocyte retrieval was carried out either 34 or 38 h after HCG administration. Each follicle was analysed for prorenin, active renin, VEGF and estradiol. Oocytes were evaluated for quality (mature, immature, degenerated oocytes), as were the embryos (low or high).
  
  
  RESULTS
  In the HCG +38 h group there were 245 follicles, and in the HCG +34 h group 240 follicles. In the HCG +38 h group, log active renin was lower (2.78 +/- 0.20 versus 2.91 +/- 0.25; P < 0.001) and VEGF higher (2276.0 +/- 790.1 versus 1946.6 +/- 954.5 pg/ml; P < 0.001). The odds ratio for obtaining oocytes from follicles was 1.6 [95% confidence interval (CI) 1.1-2.6; P = 0.02], and for developing high quality embryos 7.6 (95% CI 2.8-20.9; P < 0.001) in favour of the HCG +38 h group.
  
  
  CONCLUSIONS
  Follicular maturation and oocyte quality are related to the intrafollicular influences of active renin and VEGF in a time-dependent manner after HCG administration, whereas fertilization competence is related to VEGF only.
authors.affiliation: Reproductive Unit, Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, SI-1000 Ljubljana, Slovenia. eda.bokal@guest.arnes.si
authors.forename: E Vrtacnik
authors.initials: EV
authors.lastname: Bokal
authors.forename: H Meden
authors.initials: HM
authors.lastname: Vrtovec
authors.forename: I
authors.initials: I
authors.lastname: Virant Klun
authors.forename: I
authors.initials: I
authors.lastname: Verdenik
mesh_terms: D000328:Adult; D042501:Angiogenic Proteins / Q000378:metabolism*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage* / Q000627:therapeutic use; D004622:Embryo, Mammalian / Q000502:physiology; D004958:Estradiol; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D015571:Follicular Fluid / Q000378:metabolism; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D009865:Oocytes / Q000187:drug effects / Q000502:physiology*; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D012083:Renin / Q000187:drug effects / Q000378:metabolism; D020554:Sperm Injections, Intracytoplasmic; D042461:Vascular Endothelial Growth Factor A / Q000187:drug effects / Q000378:metabolism
chemical_list: D042501:Angiogenic Proteins; D006063:Chorionic Gonadotropin; D042461:Vascular Endothelial Growth Factor A; D004958:Estradiol; D012083:Renin