Increased erythrocyte aggregation in ovarian hyperstimulation syndrome: a possible contributing factor in the pathophysiology of this disease

Predictive Factors for Recovery Time in Conceived Women Suffering From Moderate to Severe Ovarian Hyperstimulation Syndrome

OBJECTIVE

This study aimed to evaluate potential predictors for recovery time in pregnant patients with moderate to severe ovarian hyperstimulation syndrome (OHSS).

METHODS

A total of 424 pregnant patients with moderate to severe OHSS who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were retrospectively identified. The clinical features and laboratory findings within 24 h after admission were collected. Treatment for OHSS was carried out according to standard procedures, including fluid replacement therapy, human albumin, aspirin, low-molecular-weight heparin, and paracentesis, when necessary. Patients were discharged from the hospital when the tmorning hematocrit was <40% and no obvious clinically relevant symptoms existed, such as abdominal distension, abdominal pain, and shortness of breath. Meanwhile, ultrasound indicating little pleural or abdominal effusion and biochemical abnormalities returning to normal were required. Spearman's correlation analysis was used to assess the association between the blood-related parameters and recovery time. Multiple linear regression models were used to assess the relationship between the clinical or laboratory parameters and recovery time.

RESULTS

The median recovery time of these patients was 11 days. In Spearman's correlation test, leukocytes, hemoglobin, platelets, hematocrit, creatinine, prothrombin time (PT), fibrinogen (Fib), D-dimer, and fibrinogen degradation products (FDPs) were positively correlated with recovery time. On the other hand, albumin and thrombin time (TT) were negatively correlated with recovery time. Multiple linear regression analysis showed that polycystic ovary syndrome (PCOS), hemoglobin, platelets, albumin, and Fib were significantly associated with the recovery time of patients with OHSS (p = 0.023, p < 0.001, p = 0.007, p < 0.001, and p = 0.019, respectively).

CONCLUSIONS

In pregnant patients with OHSS, PCOS and hypoalbuminemia were associated with a significantly longer recovery time. Meanwhile, the recovery time was longer when patients have high levels of hemoglobin, platelets, and Fib.

Mass spectrometry-based glycomic profiling of the total IgG and total proteome N-glycomes isolated from follicular fluid

Couples with infertility issues have been assisted by in vitro fertilization reproduction technologies with high success rates of 50-80%. However, complications associated with ovarian stimulation remain, such as ovarian hyperstimulation. Oocyte quality is a significant factor impacting the outcome of in vitro fertilization procedures, but other processes are also critical for fertilization success. Increasing evidence points to aberrant inflammation as one of these critical processes reflected in molecular changes, including glycosylation of proteins. Here we report results from a MALDI-TOF-MS-based glycomic profiling of the total IgG and total proteome N-glycomes isolated from the follicular fluid obtained from patients undergoing fertilization through either (1) assisted reproduction by modified natural cycle or (2) controlled ovarian stimulation (GnRH antagonist, GnRH Ant) protocols. Significant inflammatory-related differences between analyzed N-glycomes were observed from samples and correlated with the ovarian stimulation protocol used in patients.

A New Perspective on the Risk of Hypercoagulopathy in Ovarian Hyperstimulation Syndrome Using Thromboelastography

Thromboelastography (TEG) provides real-time assessment of hemostasis by measuring the viscoelastic properties, coagulation factor, and platelet activity in whole blood samples. In this prospective case-control study, we wanted to investigate whether blood clot formation assessment, using TEG, can identify a hypercoagulable state in women with severe ovarian hyperstimulation syndrome (OHSS). Thirty-six women who were hospitalized with severe OHSS were allocated to the OHSS group and 32 women undergoing controlled ovarian hyperstimulation but who did not develop OHSS were allocated to the control group. The TEG indices were compared between women with severe OHSS and controls. All the coagulation indices assessed by TEG were significantly different in the OHSS group compared to the controls, depicting a hypercoagulable state. Median coagulation index was 3.6 (interquartile range: 2.80-4.15) and 1.45 (interquartile range: 0.20-2.30) in study group and controls, respectively ( P < .001). Our results show that TEG can be used to depict a hypercoagulable state in women with severe OHSS.

Tubercular Ascites Simulating Ovarian Hyperstimulation Syndrome following In Vitro Fertilization and Embryo Transfer Pregnancy

Ovarian hyperstimulation syndrome (OHSS) is a known complication of using ovulation induction drugs in assisted reproductive techniques. Its incidence and severity vary. Tuberculosis is a very common disease in the developing world, and ascites is one of its sequelae. The newer aids in diagnosing tuberculosis include measuring levels of Adenosine DeAminase (ADA) in the third-space fluids or serum. This case report is from a tertiary care center, reflecting how tubercular ascites simulated OHSS, and the right diagnosis was made and managed. This is being presented due to its rarity.

Hemorheologic profile in healthy women undergoing controlled ovarian stimulation

We investigated the hemorheologic profile in 110 women undergoing controlled ovarian stimulation and provide evidence that smokers and women with body mass index>25 kg/m2 exhibit alterations of rheologic profile. A progressive increase of whole-blood viscosity throughout the ovarian stimulation cycle was observed; deformability and aggregation of erythrocytes decreased from baseline to the beginning of recombinant FSH administration, then remained unchanged throughout the next days; hematocrit mildly decreased during the last days of recombinant FSH administration; and fibrinogen and cholesterol levels decreased and increased, respectively, throughout the stimulation cycle.

Early signaling of inflammation in acute ischemic stroke: clinical and rheological implications

INTRODUCTION

Several studies have highlighted the role of interleukin-6 (IL-6) as an early signal of the inflammatory response following acute ischemic stroke. This study examines the potential advantage of employing high-sensitivity (hs)-IL-6 as a possible biomarker at the early stages of acute stroke for identifying an acute phase response and its potential rheological and clinical implications.

METHODS

Venous blood was obtained from 186 stroke patients within 24 h of hospital admission and 3-5 days thereafter in order to characterize an inflammatory and hemorheological profile (including erythrocyte aggregation). Neurological state was assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs).

RESULTS

While most biomarkers displayed elevated concentrations with time, serum concentrations of hs-IL-6 declined 3-5 days following acute stroke. Initially elevated levels of hs-IL-6 at presentation further correlated with unfavorable clinical outcomes (by NIHSS and mRs) at both time points. Analysis of variance in the different quartiles identified an hs-IL-6 gradient-dependent correlation at both time points, such that the higher the initial hs-IL-6 concentration, the higher the elevation in inflammatory biomarkers and the poorer the neurological state at both time points (p<0.001 for NIHSS and p=0.001 for mRs, for trend across quartiles).

CONCLUSIONS

This study demonstrates the potential of employing hs-IL-6 as an early stage biomarker for the prognosis of acute ischemic stroke. Such an advance would provide the means to identify at an early stage the patients who would require closer clinical surveillance and/or administration of therapeutic interventions.

Higher C-reactive protein levels during IVF stimulation are associated with ART failure

BACKGROUND

C-reactive protein (CRP) is believed to be a sensitive marker of endothelial activation and inflammation. The association between an inflammatory state and CRP has prompted research on changes in CRP levels in assisted reproductive technique (ART) cycles. IVF success and CRP levels were not correlated previously. The aim of this prospective study was to assess CRP levels during IVF stimulation and correlate them with IVF success.

MATERIALS AND METHODS

Twenty-eight Women were stimulated using the 'Flare-up' protocol with down-regulation of Triprorelin. CRP levels were measured on cycle days 3, 8, ovum pick-up day and 12 days following embryo-transfer (betahCG testing day).

MAIN OUTCOME MEASURES

CRP levels in women who conceived after IVF protocol (n=8) were compared to CRP levels in women who failed to conceive (n=20).

RESULTS

The mean age for both groups was similar. CRP levels were significantly different on day 3 (p<0.05), but not on day 8, of the cycle. Average CRP levels on ovum pick-up and on betahCG test days were similar, as was the number of oocytes collected or embryos replaced. Patients who failed to conceive had significantly higher levels of CRP on day 3 of the cycle, before commencement of gonadotrophin administration, and the higher levels continued throughout treatment, although not reaching statistical significance.

CONCLUSIONS

An inflammatory state, indicated by high CRP levels during stimulation, may serve as a prognostic indicator of IVF success.

Elevated levels of CRP in ovarian hyperstimulation syndrome: an unrecognised potential hazard?

OBJECTIVE

Elevated levels of C-reactive protein (CRP) were found recently to be a crucial marker for cardiovascular disease. This protein might have a role in endothelial cell activation, vascular damage and a thrombotic tendency. We sought to determine whether concentrations of CRP are altered in women with controlled ovarian hyperstimulation (COH) or hyperstimulation syndrome (OHSS).

DESIGN

A prospective cohort study.

SETTING

The gynecology department and IVF unit of the Lis maternity hospital.

POPULATION

Twenty women with OHSS, 20 women undergoing COH and 20 women who participated as controls were included in the study.

METHODS

Venous blood was withdrawn for analysis of high sensitive C-reactive protein (hs-CRP) using the Boering BN-II nephelometer.

MAIN OUTCOME MEASURES

hs-CRP levels were determined.

RESULTS

There was a significant (P < 0.05) difference in the hs-CRP concentrations in women with OHSS compared with women with COH and controls. The respective values for hs-CRP were 19.0 [4.0], 7.0 [1.7] and 4.6 [1.1] mg/L.

CONCLUSIONS

Women with OHSS have elevated concentrations of hs-CRP. This finding, previously believed to merely represent an acute phase response, may actually represent a yet unrecognised pathophysiological factor of this syndrome and pave the way for new investigational directions of this potentially hazardous condition.

Association of components of the metabolic syndrome with the appearance of aggregated red blood cells in the peripheral blood. An unfavorable hemorheological finding

BACKGROUND

Components of the metabolic syndrome are associated with low-grade inflammation. This can be accompanied by the synthesis of sticky proteins and erythrocyte aggregation.

METHODS

The degree of erythrocyte aggregation was evaluated by a simple slide test and image analysis along with other markers of the acute-phase response, including the white blood cell count (WBCC), erythrocyte sedimentation rate (ESR), fibrinogen and high sensitivity C-reactive protein (hs-CRP) concentrations. Patients were categorized in four groups according to the absence or presence of 1, 2 and 3 or more components of the metabolic syndrome.

RESULTS

We examined a total of 1447 individuals (576 women and 871 men) who gave their informed consent for participation. A significant cardiovascular risk factors, age and hemoglobin adjusted correlation was noted between the degree of erythrocyte aggregation and the number of components of the metabolic syndrome (r = 0.17, p < 0.0005). This correlation was better than that observed for clottable fibrinogen (r = 0.13 p < 0.0005), for ESR (r = 0.11 p < 0.0005) or WBCC (r = 0.13 p < 0.0005). A somewhat better correlation was noted for hs-CRP (r = 0.26 p < 0.0005).

CONCLUSIONS

The multiplicity of components of the metabolic syndrome is associated with enhanced erythrocyte aggregation, probably related to the presence of multiple adhesive macromolecules in the peripheral blood. The enhanced aggregation might contribute to capillary slow flow, tissue deoxygenation as well as vasomotor tone changes in the presence of multiple components of this syndrome.