ANGIOTENSIN-CONVERTING ENZYME-INHIBITION REVERSES LUTEAL-PHASE STEROID-PRODUCTION IN OOCYTE DONORS

Objective: To determine whether angiotensin-converting enzyme (ACE) inhibition would affect ovarian steroid synthesis in the oocyte donors undergoing controlled ovarian hyperstimulation (COH). Setting: The IVF program of the University of Southern California. Design: Prospective matched clinical trial. Patients: Twelve oocyte donors were studied in 28 hyperstimulation cycles. Interventions: Donors underwent a standard COH protocol; Follicle aspiration was performed 34 hours after administration of hCG. After the procedure, seven donors were administered the ACE inhibitor, captopril, 6.25 mg orally twice daily for 4 days, The remaining patients served as controls. Main Outcome Measures: Serum E(2), P, plasma prorenin, active renin, and angiotensin II (Ang II). Results: Angiotensin II increased after aspiration in both groups but was significantly lower in those receiving captopril, Peak P in the captopril group was significantly lower than controls (81.8 +/- 27.8 versus 208.5 +/- 23.9 ng/mL [conversion factor to SI unit, 3.180]). Peak E(2) was significantly higher (2,222.4 +/- 875.3 versus 425.6 +/- 490.4 pg/mL [conversion factor to SI unit, 3.671]). Active renin and Ang II correlated with P. Conclusions: In stimulated cycles, inhibition of Ang II production appears to raise serum E(2) and lower P levels. Angiotensin II, therefore, may have a role in the regulation of ovarian steroid synthesis.