The Effect of Ovarian Stimulation on Endothelial Function-A Prospective Cohort Study using Peripheral Artery Tonometry.
J Clin Endocrinol Metab
; 105(12)2020 12 01.
Article
em En
| MEDLINE
| ID: mdl-32968793
CONTEXT: Gonadotropin-releasing hormone agonist (GnRH-a) serves as an alternative to human chorionic gonadotropin (hCG) to trigger final oocyte maturation, while it significantly reduces the risk of ovarian hyperstimulation syndrome (OHSS), probably by attenuating vascular/endothelial activation. OBJECTIVES: The objectives of this work are to compare the effect of different modes of final follicular maturation (hCG vs GnRH-a) following ovarian stimulation (OS) for in vitro fertilization (IVF) on endothelial function. DESIGN AND SETTING: A prospective cohort study was conducted at a tertiary medical center. PARTICIPANTS: Patients age 37 years or younger, undergoing OS for IVF, were allocated into 2 groups according to the type of final follicle maturation: the hCG group (nâ
=â
7) or the GnRH-a group (nâ
=â
8). INTERVENTION: Endothelial function was assessed by measurement of the peripheral arterial tonometry in reaction to temporary ischemia at 3 study points: day 3 of menstrual cycle (day 0), day of hCG/GnRH-a administration (day trigger) and day of oocyte pick-up (day OPU). The ratio of arterial tonometry readings before and after ischemia is called the reactive hyperemia index (RHI). Decreased RHI (<â
1.67) indicates endothelial dysfunction. MAIN OUTCOME MEASURES: The main outcomes measures of this study included endothelial function at 3 study points during OS with different modes of triggering final follicular maturation. RESULTS: The mean RHI values at day 0 were within the normal range for all patients and comparable between both groups (hCG: 1.7â
±â
0.3 vs GnRH-a: 1.79â
±â
0.4, Pâ
=â
.6). All patients presented a decrease in RHI values on day trigger, which did not differ between the 2 groups (1.62â
±â
0.3 vs 1.4â
±â
0.2, respectively, Pâ
=â
.2). However, the hCG group demonstrated a further decrease in RHI on day OPU, whereas patients who received GnRH-a had restored normal endothelial function reflected by increased RHI values (1.4â
±â
0.2 vs 1.75â
±â
0.2, respectively, Pâ
=â
.03). CONCLUSIONS: Triggering final follicular maturation with GnRH-a restored normal endothelial function, whereas hCG trigger resulted in a decrease in endothelial function.
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Base de dados:
MEDLINE
Assunto principal:
Indução da Ovulação
/
Artérias
/
Endotélio Vascular
/
Fármacos para a Fertilidade Feminina
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article