Vascular Endothelial Growth Factor Overexpression
Conditions
Keywords
VEGF, Trigger, OHSS
Brief summary
Introduction OHSS still remains a complication of assisted reproduction treatments. hCG administration to trigger final oocyte maturation will release vascular mediators, being VEGF and other proteins such as VE-Cadherin or Angiopoietin- 2. It has been shown that replacing hCG by GnRH agonists will induce a very short endogenous LH peak, potent enough to induce final oocyte maturation but no OHSS will develop. The investigators examined VEGF, VE-Cadherin and Angiopoietin-2 modulation by hCG as well as GnRH agonists in oocyte donors undergoing controlled ovarian stimulation.
Detailed description
Material and Methods Between June and December of 2008 we evaluated 90 egg donors. They underwent COH with 150 IU rFSH as starting dose, we separated them in 3 groups (n:30 each): Groups 1 and 2 received a 0.25mg daily dose of GnRH antagonist when a follicle 14mm in diameter was observed. hCG 250g was given to group 1 while group 2 received triptorelin 0.2mg when leading two follicles were 17mm. Group 3 was stimulated with standard long protocol, hCG was given following similar criteria. Blood was collected the day of hCG/aGnRH administration as well as the day of egg retrieval, and follicular fluid from the first two mature follicles was also frozen. We collected granulosa cells (GC) of 10 patients of each group as well Levels of VEGF, sVE-Cadherin an Angiopietin 2 were determined by ELISA in serum and in follicular fluid. Results were analyzed via ANOVA.Data are expressed as mean± SEM. A significant difference was defined as p\< 0.05.
Interventions
None listed
Sponsors
IVI Madrid
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 34 Years
Healthy volunteers
Yes
Inclusion criteria
* Donors
Exclusion criteria
* Important diseases
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| VEGF Protein and mRNA Levels | 1 year | VEGF concentration in follicular fluid and VEGF mRNA expression in granulosa cells from patients who received either GnRH agonist instead of hCG |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Antagonist-hCG to Trigger Protocol with antagonist and hCG to trigger oocyte maturation | 32 |
| Antagonist-aGnRH to Trigger Protocol with antagonist and 0.2 mg triptorelin to trigger oocyte maturation | 32 |
| Long Protocol-hCG Long Protocol and hCG to trigger oocyte maturation | 32 |
| Total | 96 |
Baseline characteristics
| Characteristic | Antagonist-aGnRH to Trigger | Long Protocol-hCG | Antagonist-hCG to Trigger | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 32 Participants | 32 Participants | 32 Participants | 96 Participants |
| Age, Continuous | 23.7 years STANDARD_DEVIATION 3.9 | 24.5 years STANDARD_DEVIATION 3.7 | 27.2 years STANDARD_DEVIATION 3.5 | 25.1 years STANDARD_DEVIATION 3.7 |
| Region of Enrollment Spain | 32 participants | 32 participants | 32 participants | 96 participants |
| Sex: Female, Male Female | 32 Participants | 32 Participants | 32 Participants | 96 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 32 | 0 / 32 | 0 / 32 |
| serious Total, serious adverse events | 0 / 32 | 0 / 32 | 0 / 32 |
Outcome results
Primary
VEGF Protein and mRNA Levels
VEGF concentration in follicular fluid and VEGF mRNA expression in granulosa cells from patients who received either GnRH agonist instead of hCG
Time frame: 1 year
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Antagonist-hCG Levels of VEGF | VEGF Protein and mRNA Levels | 1395 pg/ml | Standard Deviation 284 |
| Antagonist-aGnRH Levels of VEGF | VEGF Protein and mRNA Levels | 1069 pg/ml | Standard Deviation 354 |
| Long Protocol- hCG | VEGF Protein and mRNA Levels | 1666 pg/ml | Standard Deviation 55 |
Comparison: ANOVA for three groupsp-value: <0.001ANOVA