SERUM VASCULAR ENDOTHELIAL GROWTH-FACTOR AND DOPPLER BLOOD-FLOW VELOCITIES IN IN-VITRO FERTILIZATION - RELEVANCE TO OVARIAN HYPERSTIMULATION SYNDROME AND POLYCYSTIC OVARIES

Objective: To relate changes in serum and follicular fluid vascular en dothelial growth factor (VEGF) concentrations to Doppler blood flow ve locities within ovarian and uterine blood vessels during IVF cycles an d to assess their relation to ovarian hyperstimulation syndrome (OHSS) and polycystic ovaries (PCO)/polycystic ovary syndrome (PCOS). Design : Prospective descriptive study. Setting: The London Women's Clinic. P atient(s): One hundred seven patients receiving a ''long'' stimulation protocol of IVF. Intervention(s): Doppler blood flows were recorded i n ovarian stromal and uterine arteries; serum VEGF was measured in the early follicular phase, after pituitary desensitization, on the day o f hCG administration, on the day of oocyte retrieval, and on the day o f ET. Main Outcome Measure(s): Serum and follicular fluid VEGF concent rations and Doppler blood flow measurements. Result(s): Serum VEGF con centrations rose after hCG administration. The rise was higher in wome n in whom OHSS developed. Women with PCO/PCOS had higher serum VEGF co ncentrations throughout the IVF cycle irrespective of whether OHSS dev eloped. Follicular fluid VEGF concentrations were higher in women in w hom OHSS developed and in women with PCO/PCOS. Doppler blood how veloc ities in the ovarian blood vessels were higher in women in whom OHSS d eveloped. Within ovarian and uterine blood vessels? blood flow velocit ies were higher in the early follicular phase and on the day of hCG ad ministration in women with PCO/PCOS. A positive correlation was observ ed between the serum VEGF and E-2 concentrations on the days of hCG ad ministration and oocyte retrieval and between the serum VEGF concentra tion and Doppler blood flow velocities throughout the IVF cycle. Concl usion(s): Our results support the role of VEGF as a mediator of OHSS a nd establish a possible link between VEGF, OHSS, and PCO. (Fertil Ster il(R) 1998,70:651-8. (C) 1998 by American Society for Reproductive Med icine.).