Human Reproduction, Vol. 8, No. 12, pp. 2039-2046, 1993
© 1993 European Society of Human Reproduction and Embryology
review-article |
Endocrinology: von Willebrand factor: an endothelial marker to monitor in-vitro fertilization patients with ovarian hyperstimulation syndrome*
1Department of Reproductive Medicine, University Hospital for Obstetrics and Gynaecology Universitätsstrasse 21-23, D-8520 Erlangen 2Institute for Transfusion Medicine, University Hospital for Erlangen-Niirnberg Germany
Correspondence: 3To whom correspondence should be addressed
A retrospective study was conducted to evaluate the possible role of endothelial and extracellular factors in the pathophysiology of ovarian hyperstimulation syndrome (OHSS). Plasma changes in von Willebrand—Jürgen factor were correlated with the clinical condition of hyperstimulated patients, since the rise of capillary permeability is the central event in all subsequent morbidity. The corresponding oestradiol levels and ultrasound parameters were assessed. In-vitro fertilization patients designated as ‘high responders’ and with oestradiol values >2500 pg/ml and >8 pre-ovulatory follicles at the time of human chorionic gonadotrophin (HCG) injection were assessed. Among 62 patients, 37 fulfilled these criteria and 18 developed OHSS, indicating the low predictive ability of ultrasound and oestradiol values alone. The remaining 19 patients served as control group. von Willebrand factor-associated antigen in plasma was measured using enzyme-linked immunosorbent assay and ristocetin co-factor activity by an aggregatometric test. Basal values of the two groups of patients did not differ but there were large inter-individual variations. A slight increase occurred in the control group until the day of HCG although individual cycles showed ‘no change of pattern’ or a ‘decreasing tendency’ from the start. Some patients allocated to the non-hyperstimulated type showed a steep increase of values followed by a decline. A consistent increase in the OHSS group lasted after embryo transfer even to the late corpus luteum phase. These subtle changes of capillary permeability or damage always preceded the clinical signs, such as ascites, haemoconcentration, hypoproteinaemia and pleural effusion. Mean values differed in the two groups from the day preceding ovum retrieval. This test may therefore provide an additional ‘prognostic marker’ for early recognition and monitoring of OHSS.
Key words: endothelial permeability/IVF/ovarian hyperstimulation/pathophysiology/von Willebrand factor
*Presented in part at the 8th Annual Conference of the European Society of Human Reproduction, July 8–12, 1992, Den Haag, The Netherlands