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 E2, 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 E2 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 E2 and lower P levels. Angiotensin II, therefore, may have a role in the regulation of ovarian steroid synthesis.