Characterization of intraperitoneal cytokines and nitrites in women with severe ovarian hyperstimulation syndrome

Objective: To assess the potential involvement of cytokines and nitrites in the hyperpermeability characterizing the ovarian hyperstimulation syndrome (OHSS). Design: A controlled clinical study comparing peritoneal fluid (PF) from patients with severe OHSS and from non-OHSS controls. Setting: Women hospitalized with severe OHSS in three tertiary medical centers. Patients: Twelve patients with severe OHSS necessitating paracentesis and 20 non-OHSS controls. Interventions: The criteria for ultrasound-guided paracentesis were tense ascites, hydrothorax, hemoconcentration, or oliguria. Main Outcome Measures: Interleukin (IL) 1 beta IL-1 receptor agonist, IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNF alpha) levels in PF were assayed by ELISA; nitrites were measured by the ''Griess'' reaction. Estradiol and P were determined by RIA. Results: Ovarian hyperstimulation syndrome patients had significantly higher PF IL-6 (3,523 versus 30 pg/mL), TNF alpha (14 versus 4.2 pg/mL), and IL-8 (1,695 versus 900 pg/mL). In the serum, only IL-6 levels were significantly higher (375 versus 11 pg/mL). Conversely, nitrite levels were significantly lower in PF of OHSS patients (0.5 versus 34 nmol/mL). Interleukin 1 levels were higher and IL-1 receptor antagonist levels were lower in OHSS patients, suggesting potentially increased biologic potency of IL-1. Conclusion: These findings suggest that these substances could be involved in mediating the capillary hyperpermeability characterizing this syndrome.