The Effect of Retinoic Acid and Bevacizumab on Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is an undesired outcome of controlled ovarian stimulation, commonly used in infertility treatment during in vitro fertilization and intrauterine insemination cycles. This study aimed to investigate whether retinoic acid and bevacizumab have an effect on the prevention of OHSS.

A hyperstimulation model was created using 40 Wistar albino rats, each 22 days old. The rats were divided into four groups. Group 1 was the negative control group, Group 2 was the positive control group, Group 3 was the bevacizumab-administered group after ovarian hyperstimulation, and Group 4 was the retinoic acid-administered group after ovarian hyperstimulation. Serum estradiol and vascular endothelial growth factor (VEGF) levels were evaluated. Peritoneal fluid was collected using a syringe, and the presence of peritoneal fluid was recorded observationally. Hematoxylin and eosin staining and Masson's trichrome staining were performed on the ovaries. Immunohistochemical staining for VEGF and estrogen receptors was conducted.

Retinoic acid treatment significantly reduced peritoneal fluid and inhibited fluid leakage, whereas bevacizumab treatment resulted in a slight reduction of peritoneal fluid. The number of tertiary and secondary follicles remained unaffected by both bevacizumab and retinoic acid treatment. However, the number of primary follicles significantly decreased in the bevacizumab and retinoic acid treatment groups. Retinoic acid treatment significantly reduced estrogen receptor (ER) in the stromal compartment.

Both retinoic acid and bevacizumab appear to be effective in treating OHSS. Additionally, retinoic acid and bevacizumab influence the initial stages of follicular development. Future studies are essential to determine the optimal dosage and timing for these therapeutic agents.