Objective: Ovarian Hyperstimulation Syndrome (OHSS) is a serious complication of In Vitro Fertilisation (IVF) treatment. It is estimated that 3-5% of treated women suffer of severe form of OHSS. OHSS pathogenesis remains unknown and its treatment is only symptomatic. It is difficult to predict the risk of OHSS of an individual woman, since a current criterion--the number of punctured follicles--is not very reliable. Our aim was to find, whether in patients with a high risk of OHSS (more than 18 follicles punctured for oocyte pick-up) is possible to predict the individual risk of OHSS. As a marker we tested concentrations of Pregnancy Associated Plasma Protein-A (PAPP-A) in follicular fluid (FF) and blood serum (S).
Study design: Prospective study.
Settings: Assisted Reproduction Center, Clinic of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital in Prague.
Methodology: Follicular fluid and serum of 118 female patients undergoing IVF treatment was collected at the day of oocyte pick-up and analysed for PAPP-A concentration. The resulting data were then correlated with the OHSS status of individual patient.
Results: Mean concentration of PAPP-A in FF was 0.81 +/- 0.29 IU/l, while in S it reached only 0.0017 +/- 0.0003 IU/l. Patients with subsequent OHSS grade 1, 2 and 3 reached FF levels of PAPP-A 0.81; 0.52; and 0.73 IU/l, respectively 0.0017; 0.0017 a 0.0017 IU/l in blood serum. No correlation was found between PAPP-A FF or PAPP-A serum concentrations and the degree of OHSS. No correlation was found between PAPP-A serum concentrations and the number of follicles.
Conclusion: 1. Pathological response on hormonal stimulation leading to OHSS is not related to the concentrations of PAPP-A in either FF or in blood serum. 2. PAPP-A does not pass from follicles to blood in a significant amount.