Etiology of OHSS

To the Editor:

I read with interest the recently published discussion on the etiology and prevention of OHSS (1). While the review comprehensively covered its aims, there are some issues that should be highlighted.

OHSS, being a major complication of controlled ovarian hyperstimulation (COH), is characterized by marked ovarian enlargement and acute third space fluid sequestration that almost always develops after hCG administration or in early pregnancy. OHSS is similar to vascular leak syndrome (VLS), which may be attributable to the massive increase in systemic inflammatory cytokines, including vascular endothelial growth factor (VEGF), observed also during the course of severe OHSS (2).

As was already mentioned (1), many factors and mediators have been proposed as the intermediate, released by gonadotropin-hyperstimulated ovaries at ovulation, which causes the increase in capillary permeability. However, no significant evidence exists to prove any absolute or ultimate role of these ovarian regulators in the pathophysiology of OHSS (2).

Re: Elevated ghrelin levels in the peritoneal fluid of patients with endometriosis: associations with vascular endothelial growth factor (VEGF) and inflammatory cytokines

To the Editor:

We read the article by Dziunycz et al. (1) with great interest. The aims of the study were to evaluate ghrelin concentrations in the peritoneal fluid of women with endometriosis and of control women without pelvic pathology and its associations with the levels of proinflammatory cytokines and vascular endothelial growth factor (VEGF).

Woman’s age and morphologic pattern should be taken into consideration while talking about “thin” endometrium

To the Editor:

We have read with great interest the excellent study by Miwa et al. (1) and would like to comment on the potential relationship between endometrial thickness, a woman’s age and endometrial morphologic pattern.