Prognostic role of follicular fluid tumor necrosis factor alpha in the risk of early ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition characterized by capillary hyperpermeability which can be predicted by preovulatory ovarian responses such as number of follicles. A variety of cytokines are thought to be involved in pathophysiology of this syndrome. METHODS: A prospective cohort study invloving sixty intracytoplasmic sperm injection (ICSI) patients. On the day of hCG injection, we explored the threshold of larger follicles ≥11 mm diameter with a count of ≥18 follicles for the high-risk moderate-to-severe OHSS and 13-18 follicles for the low-risk moderate-to-severe OHSS. Whereas larger follicles count of less than 13 were classified as normoresponders. Pooled follicular fluid (FF) samples of each patient were collected on the day of oocyte retrieval. Magnetic multiplex immunoassay was explored to measure the concentrations of some intrafollicular cytokines including: GM-CSF, INF-γ, TNF-α, IL-10, CXCL8/IL-8, IL-6, IL-5, IL-4, IL-2, and IL-1ß. All sixty patients underwent controlled ovarian hyperstimulation (COH) with either GnRH agonist or antagonist protocols. RESULTS: Intrafollicular TNF-α concentration was significantly different (p < 0.05) in the high-risk moderate-to-severe OHSS patients compared to low-risk moderate-to-severe OHSS patients and normoresponders. TNF-α in FF had a negative correlation with the chance of high-risk moderate-to-severe OHSS. The differences in the risk of OHSS between patients who received GnRH agonist or antagonist were not significant (p > 0.05). CONCLUSIONS: In accordance to the negative correlation of TNF-α and high risk of early OHSS, we did not expect TNF-α to play a role in increasing vascular permeability in ovarian tissues. In addition, the risk of early moderate-to-severe OHSS was not affected by different GnRH superovulation protocols.

IL-5 in follicular fluid as a negative predictor of the intracytoplasmic sperm injection outcome.

PURPOSE: To determine the prognostic value of intrafollicular concentrations of some cytokines from women undergoing ovarian stimulation in the outcome of intracytoplasmic sperm injection/embryo transfer (ICSI/ET) cycles. METHODS: A total of 80 patients were included in this study following ovarian stimulation and ICSI. Follicular fluids (FF) were collected at the day of oocyte retrieval. Ten cytokines including: tumor necrosis factor- alpha (TNF-α), interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, CXCL8/IL-8, IL-10, granulocyte-macrophage colony stimulating factor (GM-CSF), and interferon gamma (IFN-γ) were measured using magnetic multiplex immunoassays. RESULTS: Only the concentration of IL-5, IL-4, and GM-CSF in FF were significantly different (p < 0.05) between ICSI cycles that resulted in pregnancy and those that failed. Elevated FF IL-5 levels were associated with poor oocyte quality, which decreases the chance of both biochemical and clinical pregnancy. Higher FF GM-CSF associated with decrease of mature oocytes, while higher FF IL-4 concentrations were linked to good ICSI outcome through increased fertilization rate. CONCLUSIONS: The elevated intrafollicular concentrations of IL-5 seem to be a negative predictor to the pregnancy outcome in ICSI cycles.