Elevated levels of interleukin-2, soluble interleukin-2 receptor alpha, interleukin-6, soluble interleukin-6 receptor and vascular endothelial growth factor in serum and ascitic fluid of patients with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To investigate the possible role of vascular endothelial growth factor, interleukin-2, soluble interleukin-2 receptor alpha, interleukin-6 and soluble interleukin-6 receptor in the pathogenesis of ovarian hyperstimulation syndrome. STUDY DESIGN: The study group consisted of 10 healthy women who developed severe ovarian hyperstimulation syndrome, group A (n=10), following ovarian stimulation by long GnRHa/hMG protocol for IVF. A control group B=10 patients underwent stimulation with the same protocol and did not develop OHSS. Blood and ascitic fluid samples were assayed for VEGF, IL-2, sIL-2Ralpha, IL-6 and sIL-6R by ELISA. RESULTS: The mean serum levels of IL-2, sIL-2Ralpha, IL-6, sIL-6R and VEGF in OHSS group were 297.5+/-190, 6588+/-5566, 40.6+/-16.6, 5280+/-3326 and 492+/-165 pg/ml as compared to 50.8+/-17.4, 1100+/-391.6, 8.5+/-3.5, 516+/-342 and 167+/-31.3 pg/ml in the control group, respectively, P<0.001. The mean ascitic fluid IL-2, sIL-2Ralpha, IL-6, sIL-6R and VEGF in the OHSS group were 282.5+/-191.5 pg/ml, 26020+/-13 995, 90.5+/-36, 14900+/-2789 and 660+/-359 pg/ml as compared to 32+/-14.8, 1206+/-429.4, 12.6+/-1.7, 614+/-240 and 151+/-20.5 pg/ml, respectively, P<0.001. CONCLUSIONS: The significantly high levels of VEGF in patients with severe OHSS suggest that VEGF is a major capillary permeability agent in OHSS. Elevated levels of IL-6 in serum and peritoneal fluid support the hypothesis that IL-6 may serve as a marker of OHSS. Although serum and ascitic fluid levels of IL-2 were elevated, accumulating evidence does not support a pivotal role for IL-2 in the pathogenesis of OHSS. However, it may have a peripheral role in mediating an increase in vascular permeability. Soluble IL-2Ralpha and sIL-6R may be considered to be involved in OHSS. However, the patho-physiologic mechanism is the subject of further investigations. Clinical application of VEGF-receptors in the management of OHSS is awaited with interest.

Second-trimester termination of pregnancy by extra-amniotic prostaglandin F2alpha or endocervical misoprostol. A comparative study.

BACKGROUND: To compare the efficacy and side effects of extra-amniotic prostaglandin F2alpha with intracervical misoprostol for midtrimester termination of pregnancy METHODS: Forty women were randomized to receive either intracervical misoprostol or extra-amniotic prostaglandin F2alpha for termination of pregnancy for congenital abnormalities or intrauterine fetal death. Induction-abortion interval and the incidence of side effects were analyzed for both groups. RESULTS: All women in the PGF2alpha group; aborted within 28 hours, 16 (80%) of which aborted within 20 hours. Medical termination of pregnancy was complete in 13 cases (65%). In the misoprostol group; all women aborted within 20 hours, 18 (90%) of which aborted within 13 hours. Medical termination of pregnancy was complete in 17 cases (85%). The induction to abortion intervals for the extra-amniotic PGF2alpha and intracervical misoprostol were 16+/-5.9 hours, and 10.3+/-4 hours (mean+/-s.d.) respectively. This was statistically significant (p=0.001). The incidence of prostaglandin-associated pyrexia, vomiting and diarrhea were significantly increased in the PGF2alpha group (p<0.05). Abdominal pain was similar in both groups. There was no post-abortive hemorrhage or infection. CONCLUSIONS: Misoprostol is an effective, easy to use, safe and cheap drug for termination of second trimester pregnancy. Intracervical administration of misoprostol appears to be effective and well-tolerated with less side effects and no complications. Larger, randomized comparative studies should be carried out to assess its potential advantages.