History and Objective: Ovarian hyper stimulation syndrome (OHSS) is a dangerous iatrogenic complication of ovulation induction cycles. Considering HCC injection complications, reports of GnRH agonist effectiveness and safety in other countries and no report in Iran, in order to determine GnRH agonist effect on ovulation induction cycles in OHSS risk, this study was performed in Mirza Koochak Khan Hospital in 5004-2000. Considering HCC's essential role in OHSS, in ovulation induction cycles with many follicle number and estradiol level elevation, HCC injection is not recommended. GnRH agonist was used for final oocyte maturation and ovulation stimulation; in order to inhibit OHSS risk and Material and Methods: A clinical trial was performed on women in ovulation induction cycle combined with IUI that were in OHSS risk. Patients were randomized in case and control group. Case group received GnRH agonist and the control group didn't. Progesterone level was measured on 21 st or 23rd day of period cycle and was followed for ovulation, pregnancy and OHSS.Results: 34 patients of total 70 that had suitable conditions were studied. Patients were matched for age and estradiol level. Ovulation rate in case and control group was 50% and 74/1%, respectively that was not statistically significant. There was no case of OHSS in both groups.Conclusions and Recommendations: Results have revealed that GnRH agonist injection in hyper stimulated cycles will be successful and prevent OHSS. Therefore its application is recommended.

Fertility and ovulation are affected by hormones and drugs. Hypericin is one of the drugs affecting the ovulation by neurotransmitters such as dopamine. Hypericin is an important component of Hypericum perforatom (S Johns Wot) used in treatment of depression and its important side effect is photosensitivity. In present study, the effect of hypericin on rat ovulation was evaluated. This study was carried as following on 30 female immature 25-day rats. At first day, PMSG was administrated to all rats at nine o'clock in the morning except control group.The control group was kept without drugs and under similar conditions with other groups. No drug was administrated on the second day of study. Positive control group (1) received gonadotropine at dose of 800 ng subcutaneously on day 3. Positive control group (2) received phenobarbital at dose of 4mg/kg interaperitoneally at one o'clock in the afternoon and positive control (3) received phenobarbital at dose of 4mg/kg interaperitoneally at one o'clock in the afternoon and GnRH at dose of 800 ng subcutaneously 2 hours later. Test group (1) was similar to positive control (3), in addition, hypericin was administrated orally at dose of 25mg/kg 30 min before phenobarbital. Test group (2) was similar to test group (1), but hypericin was given at dose of 50mg/kg. The rats were euthanized on day 4 of study at nine o’clock in the morning.The number of mature follicles, hyperemic follicles and corpus hemoragicum was counted. The results showed that administration of hypericin increased growth of follicles and number of mature follicles, hyperemic follicles, and corpus hemoragicum and it enhanced ovulation in comparison to control. However, a final comment on the mechanisms of hypericin effect needs the measurement of related hormones and neurotransmitters.

Introduction: Pulsatile injection of GnRH in hypothalamic amenorrhea is known to result in ovulation. The aim of this research was to study the effect of non pulsatile GnRH agonist administration on the ovaries of immature rats. Material and Methods: In this research the immature rats was divided to 7,17 and 27 daysand each were subdivided to four subgroups. Subcutaneous injection every 12 hours for 3 consecutivedays was carried out, and mature rats were used as a second control group. After spinal transetion, the ovaries were excised and processed for histolgical study using 5µm serial section. Results: The results were as follows, 1- In the 7 day rats high dose injection significantly decreasedthe number of vesicular follicles compared to control group. No significant difference was observed in the other groups with the same dosage. 2- In the 17 day rats high dose injection significantly increased the number of primary follicles but decreased the primary and secondary vesicular follicles. In contrast,the middle dose in comparison to high dose administration resulted in significant increase in the number of primary and secondary vesicular follicles, but not the primary follicles. Low doseadministration in the same group, showed no significant change compared with the control group.3- In the 27 day group the high dose did not result in any change in the number of primary follicles andvesicular follicles, but decreased the number of secondary vesicular and graffian follicles, and the number of corpus luteums obviously increased, similar to middle dose administration. This was incontrast to high dose which the number of secondary vesicular and graffian follicles increased and the number of corpus luteum, as compared to former group also significantly increased. 4- Comparisonbetween immature 27 day and 60 day mature rats showed decrease in the primary follicles andvesicular follicles while increase in the number of secondary and graffian follicles and corpus luteum,but the middle dose administration compared to mature rats showed almost a similar pattern.Conclusion: Finally it can be concluded that the non pulsatile administration can result in maturation of follicle and may be similar to the mature group. High dose stimulates the maturation of primary follicles but suppresses maturation of graffian follicles and low dose administration dose not have any effect on maturation of follicles.

Epidemiological studies link ovulation and epithelial ovarian cancer, which frequently develops from the ovarian surface epithelium (OSE). Ovulation can be likened to an inflammatory reaction initiated by the mid-cycle luteinizing hormone surge. Each ovulation involves proteolytic breakdown of the follicle wall and ovarian surface to allow shedding of the oocyte. Serial injury and repair of the OSE thereby creates the potential for inflammation-associated genetic damage leading to neoplasia. Since ovulation is normally so regular and frequent, natural mechanisms must exist to localize and limit ovarian inflammation and minimize emergent disease. Our research suggests a role for cytokine up-regulation of HSD11B1 gene expression in this process. HSD11B1 encodes the steroidogenic enzyme 11bhydroxysteroid dehydrogenase type 1 (11bHSD1) that metabolizes substrate cortisone to anti-inflammatory cortisol. We find 11bHSD1 mRNA and enzymatic activity strongly up-regulated by the ovulation-associated cytokine interleukin-1a (IL-1 a) in cultured human OSE cells. Moreover, cortisol enhances IL1a-induced up-regulation of 11bHSD1 mRNA, providing feed-forward amplification of local anti-inflammatory signaling in these cells. We therefore propose that cytokine activation of cortisol regeneration via 11bHSD1 can provide a mechanism for anti-inflammatory ‘protection’ of ovary during ovulation. In support of this concept, we find that IL1a up-regulates matrix metalloproteinase (MMP) 9 (gelatinase B) activities in OSE cells and this is suppressed by glucocorticoid receptor-mediated cortisol action in vitro. Suppression of MMP9 gene expression through locally regenerated glucocorticoids has implications both for normal ovulation and ovarian cancer spread. Many ovarian cancer cell lines are unable to respond normally to IL- a in terms of 11bHSD1 mRNA. Likewise, many primary epithelial ovarian cancer cells show a deficient 11bHSD1 mRNA response to IL- 1a relative to normal OSE. If this translates into deficient glucocorticoid suppression of MMP9 in primary ovarian cancer, this could be a mechanism of promoting metastatic tumour spread in vivo.