Soluble CD40 ligand levels during controlled ovarian hyperstimulation--a possible culprit of systemic inflammation.
OBJECTIVE
To investigate the behavior and association of serum sex-steroids and serum CD40 ligand in patients undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).


METHODS
Prospective, observational study.


METHODS
The IVF unit of an academic medical center.


METHODS
Blood was drawn three times during the COH cycle from 17 patients undergoing the long gonadotropin-releasing hormone-analog protocol: (i) day on which adequate suppression was obtained (Day-S); (ii) day of or prior to administration of human chorionic gonadotropin (Day-hCG); and (iii) day of ovum pick-up (Day-OPU). Levels of sex steroids and serum CD40 ligand were compared among the three time points.


RESULTS
During gonadotropin treatment, serum ovarian sex steroids (estradiol, progesterone, free testosterone and androstenedione) significantly increased while CD40 ligand levels nonsignificantly decreased. After hCG administration, there was a significant increase in the levels of serum CD40 ligand, ovarian androgens, and progesterone, with a significant decrease in estradiol levels. No correlations were observed between CD40 ligand and ovarian sex-steroid levels or other treatment variables.


CONCLUSIONS
The administration of hCG leads to activation of systemic inflammation, as reflected by CD40 ligand levels. This, in turn, may lead to the development of ovarian hyperstimulation syndrome via several mechanisms, including an increase in several angiogenic factors.
Orvieto
Raoul
R
Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon 78306, Israel. raoulu@barzi.health.gov.il
Schachter
Benny
B
Yulzari-Roll
Vered
V
La Marca
Antonio
A
Bar
Jacob
J
Fisch
Benjamin
B
D000328:Adult; D023201:CD40 Ligand / Q000097:blood*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology*; D010062:Ovulation Induction; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*
D012739:Gonadal Steroid Hormones; D023201:CD40 Ligand