From the Experts: Bringing down the risk of OHSS

In our efforts to keep our patients and readers informed on all things fertility related, I asked Professor Waljit Dhillo, Professor of Endocrinology and Metabolism and Consultant Endocrinologist at Imperial College London, to answer some questions on the use of the hormone kisspeptin in IVF.  This he has very kindly done and my questions and his answers are below.

First, to introduce you to Professor Dhillo, the Imperial College website states:

Professor Waljit Dhillo

Professor Waljit Dhillo

Professor Dhillo’s research has identified the novel hormone kisspeptin as a potential novel therapy for infertility. Professor Dhillo has carried out the ‘first time into human’ studies of kisspeptin. He has shown that kisspeptin potently stimulates reproductive hormone release in human male and female volunteers. This work was awarded the American Endocrine Society Award for Excellence in Clinical Research and the British Society for Neuroscience Investigator Prize.

1. Could you describe in simple terms, what exactly kisspeptin is?
Kisspeptin is a protein that is naturally occurring within the body, which plays an important role in the control of reproductive hormones for fertility.

2. What led you to the discovery of kisspeptin - what were you looking for?
Kisspeptin has been shown to safely stimulate the release of reproductive hormones when given to men and women. We therefore wondered whether kisspeptin could be used to stimulate  reproductive hormone release to prepare eggs for retrieval during IVF treatment. We are pleased to report that kisspeptin does indeed safely mature eggs during IVF treatment, leading to healthy embryos, pregnancy and live births. 

3. Do you think it will change how women will experience IVF?
Many women who have had OHSS (ovarian hyperstimulation syndrome) in the past are very worried about this complication of standard IVF treatment reoccurring. We believe that kisspeptin carries a lower risk of causing OHSS than the most commonly used IVF trigger medication, hCG. We are currently conducting a study to see whether kisspeptin can safely mature eggs in women at high risk of OHSS. Anecdotally some of our patients with prior experience of OHSS have reported a much smoother experience when using kisspeptin when compared with other triggers in previous cycles (see below).  

"We took part because we wanted to pay it forward in return for the people who made it possible for us to have a child through IVF," said his mother Alison Harper, 31, of Hertfordshire.
"I went through several cycles of IVF previously but the one in the trial was the least uncomfortable - it was less painful and I felt less swollen.”

4. Do you think using kisspeptin will reduce the length of time of the stimulation phase?
Kisspeptin has not been studied during the stimulation phase as of yet, but this may represent another avenue for future research. 

5. It seems that the general movement in IVF is towards lower dosages & gentler drugs.  Do you have any views on how IVF will move forward/change in the future?
Women having IVF treatment are usually healthy and well prior to starting treatment. It is, therefore, very important to be able to maintain a woman's health and reduce the risk of dangerous complications such as OHSS (ovarian hyperstimulation syndrome) whilst also offering them an opportunity to have children. Therefore gentler medications such as kisspeptin may well represent an important treatment option for women at risk of overstimulating during IVF treatment in future.

6. If you look at our blog at the moment you'll see that Professor Richard Fleming (from the GCRM) has made some comments on how he sees kisspeptin influencing IVF.  Do you agree with these comments?
I agree with Professor Fleming in that it is still early days for the use of kisspeptin in IVF. Further research is required in order to be able to compare the efficacy of IVF triggering using kisspeptin with other currently used IVF triggers. If we are able to show that kisspeptin is at least as effective and safer than currently used triggers, then we may at that stage be able to see a much bigger influence on the IVF field with kisspeptin.