Prognostic importance of serial cytokine changes in ascites and pleural effusion in women with severe ovarian hyperstimulation syndrome

Objective: To determine the prognostic value of various cytokine levels in ascites and pleural effusion during the evolution of severe ovarian hyperst imulation syndrome (OHSS). Design: A longitudinal study. Setting: University teaching hospital. Patient(s): Twenty patients with severe OHSS who required either paracentes is or thoracentesis or both from whom ascites (n = 56) or pleural effusion (n = 12) samples were obtained. Control peritoneal fluid was obtained from 20 patients undergoing ovarian stimulation for IVF. Intervention(s): Abdominal paracentesis for tense ascites and thoracentesis for massive pleural effusion. Control peritoneal fluid was obtained before oocyte retrieval. Main Outcome Measure(s): Levels of interleukin-1 beta (IL-1 beta), interleu kin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) , vascular endothelial growth factor (VEGF), E-2, and progesterone concentr ations in ascites and pleural effusion. Result(s): Levels of VEGF and IL-6 in ascites dropped significantly during the course of OHSS and were not correlated with E-2 concentrations. Levels of VEGF were significantly correlated with levels of IL-1 beta, IL-8, and T NF-alpha, as well as progesterone concentrations, hematocrit, and white blo od cell counts. None of the cytokine levels measured in pleural effusion we re correlated with the course of OHSS. Conclusion(s): These results suggest that local cytokines might be involved in the evolution of severe OHSS and possibly serve as prognostic markers f or this syndrome. (C) 1999 by American Society for Reproductive Medicine.