ELEVATED LEVELS OF INTERLEUKIN-6 IN ASCITES AND SERUM FROM WOMEN WITHOVARIAN HYPERSTIMULATION SYNDROME

Objective: To examine the role of pro-inflammatory cytokines in ovaria n hyperstimulation syndrome (OHSS). Design: In vitro laboratory study of serum, peritoneal cells isolated and fluid obtained from ascites re moved in the therapeutic management of four patients with OHSS. Settin g: Tertiary care referral teaching hospital. Patients: Four patients w ith OHSS comprised the study population. Five healthy women at the tim e of elective laparoscopic tubal ligation served as controls. Control serum was also obtained from healthy adult volunteers, and control per itoneal fluid (PF) was obtained from patients on peritoneal dialysis. Interventions: Therapeutic paracentesis was performed on four patients with OHSS. Results: Peritoneal cells were isolated and fluid obtained from ascites removed in the therapeutic management of the women with OHSS. Peritoneal cells were obtained by intraoperative lavage from the control women. The cells were incubated with various concentrations o f Escherichia coli lipopolysaccharide (LPS) for 20 and 48 hours. Inter leukin-1beta (IL-1beta), tumor necrosis factor (TNF), interleukin-6 (I L-6), and prostaglandin E2 (PGE2) were assayed in the incubation super natants. The release of the three cytokines and PGE2 in response to LP S by peritoneal cells from women with OHSS was not different from the controls. However, both serum and ascitic fluid from women with OHSS c ontained significantly greater levels of IL-6 than control serum and P F. No significant differences in TNF levels in serum, ascitic fluid, o r PF could be found by ELISA or bioassay. Conclusions: Increased produ ction of IL-6, released into the peritoneal cavity and the circulation , may mediate OHSS.