Study for the etiology and therapy of polycystic ovary syndrome and ovarian hyperstimulation syndrome.

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A.We investigated the mechanisms of ovulation failure of polycystic ovary syndrome(PCOS) using dehydroepiandrosterone-induced PCO rats. Serum testosterone, androstenedione and DHEAS levels in PCO rats were significantly higher than those in control rats. Histological study also showed multiple cysts in the ovary of PCO rats. Matirix metalloproteinase activity in ovaries of PCO rats was less than that of control rats. Lysyl oxidase activity in ovaries of PCO rats was more than that of control rats. These changes seem to inhibit breakdown of follicular wall during ovulation.B.We assessed the relationship between vascular endothelial growth factor (VEGF) system and ovarian hyperstimulation syndrome (OHSS) using OHSS rats. Serum progesterone (P4) and estradiol (E2) significantly increased in OHSS rats compared to superovulated rats. Ovarian weight significantly increased compared to superovulated rats. VEGF expression in ovaries of OHSS rats also increased compared to superovulated rats. Gonadotropin releasing hormone agonist (GnRHa) treatement reduced ovarian weight of OHSS rats. GnRHa also reduced serum P4, E2 and VEGF expression. These results propose that an increase in VEGF expression may related to OHSS and that GnRHa treatment may be a candidate for medication to prevent OHSS.C.We examined the effects of the continuation of GnRHa for a week after hCG injection on patients who were at risk for OHSS and had elective cryopreservation after in vitro fertilization. In patients who had just elective cryopreservation, 5% of patients developed OHSS necessitating hospitalization because of a marked increase in ascites in the upper abdomen and the hemoconcentration. However, none developed OHSS in GnRHa-continuation group. On the other hand, continuation of GnRHa did not reduce the rates of oocytes fertilized and pregnancy. This is a thoroughly safe and cost-beneficial treatment which should be performed promptly for patients who are at riskfor OHSS.