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Manalai G, Shirzai A, Aalemi AK. High Dose Cabergoline in Management of Bilateral Ovarian Hyperstimulation Syndrome: A Case Report. Int Med Case Rep J 2021; 14:557-561. [PMID: 34466037 PMCID: PMC8403006 DOI: 10.2147/imcrj.s318485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to excess hormones and is also one of the life-threatening iatrogenic complications which is associated with ovulation induction. This syndrome usually occurs in women who receive injectable hormones for the stimulation of egg development in the ovaries. This study describes a rare case of moderate ovarian hyperstimulation syndrome which has been managed and treated with high-dose cabergoline. The patient was diagnosed in the Medical Imaging and Radiation Sciences Department of Kabul University of Medical Sciences and treated in Shahrara Teaching Hospital. A 26-year-old woman was diagnosed with the development of bilateral moderate ovarian hyperstimulation syndrome after receiving clomiphene citrate in dose of 100 mg BID on day 5 of period and Human Chorionic Gonadotropin (HCG) 10,000 units for egg release on day 14 of period. The patient was given a high dose of cabergoline. The dose was adjusted to 1 mg/day for eight days since she was diagnosed with ovarian hyperstimulation syndrome. Consequently, the main outcome of our intervention was complete resolution of OHSS as well as complete recovery of the patient. As a result, it is concluded that the high dose of cabergoline prevents and reduces the occurrence, prolongation, and severity of ovarian hyperstimulation syndrome. However, more assessments through randomized controlled trials regarding the efficacy and safety of cabergoline doses and treatment duration for treatment and preventive purposes are required.
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Affiliation(s)
- Gulparkha Manalai
- Department of Obstetrics and Gynecology, Shahrara Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Asadullah Shirzai
- Department of Medical Imaging and Radiation Sciences, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Ahmad Khalid Aalemi
- Department of Epidemiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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Zhao J, Xu B, Huang X, Yan Y, Li Y. Whether Letrozole could reduce the incidence of early ovary hyperstimulation syndrome after assisted reproductive technology? A systematic review and meta-analysis. Reprod Health 2020; 17:181. [PMID: 33218353 PMCID: PMC7678310 DOI: 10.1186/s12978-020-01042-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Letrozole can significantly decrease the estrogen level, and has been administrated to prevent the incidence of early ovary hyperstimulation syndrome (OHSS). However, the effect of Letrozole on prevention of OHSS reached to controversial conclusions. The present meta-analysis aim to examine whether Letrozole could reduce the incidence of early OHSS after assisted reproductive technology (ART). Methods An exhaustive electronic literature search was conducted on MEDLINE, Google Scholar, CNKI and WANFANG MED ONLINE, from inception until May 2018. We include clinical trials that examined the effect of Letrozole on the prevention of early OHSS. The main outcome measures were the incidence of total early OHSS, mild early OHSS, moderate early OHSS, and severe early OHSS. Results Eight studies included in the review. Of these, five publications evaluated the effect of Letrozolel on the prevention of total, mild, moderate, and severe OHSS, respectively. The results indicated that there was a significantly decreased incidence of total OHSS with Letrozole compared with control group, and there were no significantly differences in the incidence of mild, moderate, and severe OHSS between study group with Letrozole and control group. Eight studies reported the incidence of moderate + severe OHSS. We found a significant decrease in incidence of moderate + severe OHSS in high-risk women with Letrozole. Conclusions Letrozole has no beneficial effect on the prevention of mild, moderate, and severe OHSS, individually; Letrozole should not be considered as the first-line treatment for prevention of OHSS. Further cohort studies are required to explore the effect of Letrozole on the prevention of OHSS. Plain English Summary This study aimed to examine whether Letrozole could reduce the incidence of early OHSS after assisted reproductive technology (ART). A meta-analysis including 8 studies was conducted. There were no significantly differences in the incidence of mild, moderate, and severe OHSS between study group with Letrozole and control group. Letrozole has no beneficial effect on the prevention of mild, moderate, and severe OHSS, individually.
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Affiliation(s)
- Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Bin Xu
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Xi Huang
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Yi Yan
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
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Petrenko AP, Castelo-Branco C, Marshalov DV, Kuligin AV, Shifman EM, Nesnova ES. Assessing the Usefulness of Severity Markers in Women with Ovarian Hyperstimulation Syndrome. Reprod Sci 2020; 28:1041-1048. [PMID: 33063288 DOI: 10.1007/s43032-020-00339-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
The present study aims to assess the usefulness of severity markers in women with ovarian hyperstimulation syndrome (OHSS). An observational study was designed including 76 women with varying degrees of severity of OHSS. Clinical history, physical examination, laboratory tests, and ultrasound measurement of the ovarian size and ascites index were carried out in all patients. Intra-abdominal pressure (IAP) was measured using an intravesical Foley Manometer catheter. Ascites index and ovarian volume increased progressively being highest in the most severe stage of OHSS. The median IAP in mild OHSS was found to be lower than that in the moderate and severe OHSS (4.0 mm, 12 mm, and 16.0 mm, respectively). Critical cases of OHSS presented the highest IAP (25.0 mm). IAP did not reach the level of intra-abdominal hypertension in mild OHSS, whereas moderate and severe OHSS was associated with intra-abdominal hypertension grade I and grade II-III, respectively. Values of IAP in critical OHSS were found similar to those observed in abdominal compartment syndrome patients. The IAP showed a strong positive correlation with ovarian volume and ascites index. The reduction of IAP after paracentesis was greater among critical OHSS patients. The ovarian volume and the level of intra-abdominal hypertension are related to the severity of OHSS and are of particular importance in the initialization of the syndrome. Ascites index is simple and convenient and can serve as an indirect marker of the abdominal reserve volume. In conjunction with clinical and laboratory data, ascites index and IAP values might be indicators for paracentesis.
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Affiliation(s)
- Aleksei Petrovich Petrenko
- Clinic Institute of Gynecology, Obstetrics and Neonatology-Hospital Clinic Barcelona, Faculty of Medicine-University of Barcelona, Institut d ´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology-Hospital Clinic Barcelona, Faculty of Medicine-University of Barcelona, Institut d ´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Dimitry Vasilevich Marshalov
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
| | - Alexander Valerievich Kuligin
- Department of Emergency Anesthesiology-Resuscitation Care and Simulation Technologies in Medicine, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
| | - Efim Munevich Shifman
- Department of Anesthesiology and Critical Care, State Budgetary Healthcare Institution of Moscow Region M.F. Vladimirsky Moscow's Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Sergeevna Nesnova
- City Clinical Hospital №1 named after Yu.Ya. Gordeev, Saratov, Russian Federation
- Department of Hospital Surgery, Saratov State Medical University named after V. I. Razumovsky, Saratov, Russian Federation
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Dzhakupov D, Kudaibergenov T, Sultanova J, Barmanasheva Z, Zholdasov R. SYNDROME OF HYPERSTIMULATED OVARIES. EXPERIENCE IRM. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The article presents the experience of the gynecological department of the Institute of Reproductive Medicine in the conservative treatment of hyperstimulated ovary syndrome in women who underwent ovulation stimulation in the IVF center.
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Darii N, Pavlovic M, Doroftei B, Emil A. Unsuspected adverse effect of albumin in severe ovarian hyperstimulation syndrome: a case report. JBRA Assist Reprod 2019; 23:430-433. [PMID: 31058477 PMCID: PMC6798593 DOI: 10.5935/1518-0557.20190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complications
of in vitro fertilization (IVF). We present a case of OHSS
maintained and aggraved by albumin administration. A 29-year-old woman with
severe OHSS was treated with albumin perfusion according to the guidelines. The
albumin was administered in order to maintain intravascular oncotic pressure and
to reverse the shift of fluid from the intravascular to the third space, but
this therapeutic measure resulted in inadvertent maintenance of the syndrome.
The treatment of OHSS is a delicate balance between invasive approaches, such as
paracentesis, administration of colloids and minimal therapeutic intervention,
particularly during pregnancy.
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Affiliation(s)
- Natalia Darii
- Department of Gynecology, CHU de Charleroi, Montigny-le-Tilleul, Belgium
| | - Milenko Pavlovic
- Department of Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Gynecologic Laparoscopic Surgery (CECLAG), Department of Gynecology, Hospital Clínico La Florida, Santiago, Chile
| | - Bogdan Doroftei
- Department of Gynecology, University of Medicine and Pharmacology Gr T Popa Iasi, Romania
| | - Anton Emil
- Department of Gynecology, University of Medicine and Pharmacology Gr T Popa Iasi, Romania
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Abstract
Pregnancy is a normal physiologic process with the potential for pathologic states. Pregnancy has several unique characteristics including an utero-placental interface, a physiologic stress that can cause pathologic states to develop, and a maternal–foetal interface that can affect two lives simultaneously or in isolation. Critical illness in pregnant women may result from deteriorating preexisting conditions, diseases that are co-incidental to pregnancy, or pregnancy-specific conditions. Successful maternal and neonatal outcomes for parturients admitted to a maternal critical care facility are largely dependent on a multidisciplinary input to medical or surgical condition from critical care physicians, obstetric anaesthesiologists, obstetricians, obstetric physicians, foetal medicine specialists, neonatologists, and concerned specialists. Pregnant women requiring maternal critical care unit admission are relatively low in developed nations and range from 0.9% to 1%; but in our country, the admission rates of critically ill parturients range from 3% to 8%. Two-thirds of pregnant women requiring critical care are often unanticipated at the time of conception. In this review, we will look at critical illnesses in pregnant women with a specific focus on pregnancy-induced illnesses.
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Affiliation(s)
- Sunil T Pandya
- Department of Anaesthesia, Pain Medicine and Surgical and Obstetric Critical Care, Century Hospital, Hyderabad, Telangana, India.,Department of Anaesthesia, Pain Medicine and Obstetric Critical Care, Fernandez Hospital, Hyderabad, Telangana, India.,Prerna Anaesthesia and Critical Care Services Pvt Ltd., Hyderabad, Telangana, India
| | - Kiran Mangalampally
- Department of Anaesthesia, Pain Medicine and Surgical and Obstetric Critical Care, Century Hospital, Hyderabad, Telangana, India
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Chen YH, Xu XH, Wang Q, Zhang SD, Jiang LL, Zhang CL, Ge ZJ. Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol: a retrospective cohort study. J Assist Reprod Genet 2015; 32:1459-67. [PMID: 26384107 PMCID: PMC4615925 DOI: 10.1007/s10815-015-0571-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the relationship between the number of oocytes retrieved and clinical outcomes in young women with normal ovarian reserve who were undergoing their first in vitro fertilization and embryo transfer (IVF-ET) cycle. The transfer strategy based on yielded oocytes was also discussed in this article. METHODS A total of 1567 patients who underwent first long protocol of IVF treatment in our reproductive medical center between January 2010 and June 2014 were categorized into five groups based on the retrieved oocyte number, namely, 4∼6, 7∼9, 10∼12, 13∼15, and ≥16. Baseline parameters were similar among the groups. Primary outcome was defined as the cumulative live birth rate (CLBR), and secondary outcomes included the rate of patients with high risks for ovarian hyperstimulation syndrome (OHSS). RESULTS It was found that the CLBR increased with the number of oocytes, as well as the rate for high risks of OHSS. In fresh cycles, 10∼12 oocyte group demonstrated the highest implantation rate (53.32 %), clinical pregnancy rate (CPR) (73.13 %), and live birth rate (LBR) (61.14 %), with no significant differences. Moreover, both cumulative CPR (CCPR) and CLBR became significantly higher in the 10∼12 oocyte group, compared with 4∼6 and 7∼9 groups. However, when the retrieved oocytes increased to 13∼15 or ≥16, the cumulative results did not have a significant increase. Also, the high risk rate of OHSS was much lower in the 10∼12 group (11.53 %) than that in the 13∼15 group (29.97 %) and ≥16 group (77.30 %). Unconditional multivariate logistic regression analysis showed that when ≥10 oocytes were retrieved, the CLBR increased significantly (P < 0.01). When oocyte number exceeded 16, the CPR of frozen embryo transfer cycle was much higher than that of fresh cycle (P < 0.05). CONCLUSIONS For young women with normal ovarian reserve, retrieving 10∼12 oocytes might result in optimized pregnancy outcomes in a fresh cycle with low OHSS risk and would not compromise cumulative outcomes. When ≥16 oocytes were retrieved, a "freeze-all" embryo strategy might be preferable.
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Affiliation(s)
- Yuan-hui Chen
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Xiao-hang Xu
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Qian Wang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Shao-di Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Li-le Jiang
- Reproductive Medical Center, People's Hospital of Zhengzhou University, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Cui-lian Zhang
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
| | - Zhao-jia Ge
- Reproductive Medical Center, Henan Provincial People's Hospital, 450003, Weiwu Road, Zhengzhou, Henan Province, People's Republic of China.
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He Q, Liang L, Zhang C, Li H, Ge Z, Wang L, Cui S. Effects of different doses of letrozole on the incidence of early-onset ovarian hyperstimulation syndrome after oocyte retrieval. Syst Biol Reprod Med 2014; 60:355-60. [DOI: 10.3109/19396368.2014.957879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhou P, Baumgarten SC, Wu Y, Bennett J, Winston N, Hirshfeld-Cytron J, Stocco C. IGF-I signaling is essential for FSH stimulation of AKT and steroidogenic genes in granulosa cells. Mol Endocrinol 2013; 27:511-23. [PMID: 23340251 DOI: 10.1210/me.2012-1307] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
FSH and IGF-I synergistically stimulate gonadal steroid production; conversely, silencing the FSH or the IGF-I genes leads to infertility and hypogonadism. To determine the molecular link between these hormones, we examined the signaling cross talk downstream of their receptors. In human and rodent granulosa cells (GCs), IGF-I potentiated the stimulatory effects of FSH and cAMP on the expression of steroidogenic genes. In contrast, inhibition of IGF-I receptor (IGF-IR) activity or expression using pharmacological, genetic, or biochemical approaches prevented the FSH- and cAMP-induced expression of steroidogenic genes and estradiol production. In vivo experiments demonstrated that IGF-IR inactivation reduces the stimulation of steroidogenic genes and follicle growth by gonadotropins. FSH or IGF-I alone stimulated protein kinase B (PKB), which is also known as AKT and in combination synergistically increased AKT phosphorylation. Remarkably, blocking IGF-IR expression or activity decreased AKT basal activity and abolished AKT activation by FSH. In GCs lacking IGF-IR activity, FSH stimulation of Cyp19 expression was rescued by overexpression of constitutively active AKT. Our findings demonstrate, for the first time, that in human, mouse, and rat GCs, the well-known stimulatory effect of FSH on Cyp19 and AKT depends on IGF-I and on the expression and activation of the IGF-IR.
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Affiliation(s)
- Ping Zhou
- Departments of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
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Zhou X, Duan Z. A case of ovarian hyperstimulation syndrome following a spontaneous complete hydatidiform molar pregnancy. Gynecol Endocrinol 2012; 28:850-2. [PMID: 22587660 DOI: 10.3109/09513590.2012.683063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To present a rare case of ovarian hyperstimulation syndrome (OHSS) following a spontaneous complete hydatidiform molar (CHM) pregnancy. CASE A 38-year-old woman underwent vacuum curettage for a CHM pregnancy. Seven days later, she was admitted to our hospital with the symptoms of OHSS. Transvaginal ultrasonography demonstrated enlarged multicystic ovaries, marked ascites and large pleural effusions that required abdominocentesis and thoracocentesis, respectively. She was treated with intravenous fluid, exogenous colloid supplementation, prophylaxis for deep vein thrombosis, and drainage of the ascites and bilateral pleural effusions. She recovered by day 14 of admission. CONCLUSION OHSS may develop in older women who undergo treatment for CHM pregnancies. Serious complications may develop rapidly and therefore the prompt diagnosis of OHSS is very important.
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Affiliation(s)
- Xi Zhou
- Department of Obstetrics and Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
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Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2012:CD008605. [PMID: 22336848 DOI: 10.1002/14651858.cd008605.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a complication resulting from administration of human chorionic gonadotrophin (hCG) in assisted reproduction technology (ART) treatment. Most case are mild, but forms of moderate or severe OHSS appear in 3% to 8% of in vitro fertilisation (IVF) cycles. Recently, the dopamine agonist cabergoline has been introduced as a secondary prevention intervention for OHSS in women at high risk of OHSS who are undergoing ART treatment. OBJECTIVES To assess the effectiveness and safety of cabergoline in preventing ovarian hyperstimulation syndrome (OHSS) in high-risk women undergoing ART treatment. SEARCH METHODS Major medical databases (Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials, CENTRAL (The Cochrane Library), MEDLINE, EMBASE and PsycINFO) were systematically searched for randomised controlled trials (RCTs) assessing the effect of cabergoline in preventing OHSS. Databases were searched up to September 2011. Registers of clinical trials, abstracts of scientific meetings and reference lists of included studies were searched. No language restrictions were applied. SELECTION CRITERIA RCTs which compared cabergoline with placebo, no treatment or another intervention for preventing OHSS in high-risk women were considered for inclusion. Primary outcome measures included incidence of moderate or severe OHSS and live birth rate. Secondary endpoints were clinical pregnancy rate, multiple pregnancy rate, miscarriage rate and any other adverse effects of the treatment. DATA COLLECTION AND ANALYSIS Two authors independently screened titles, abstracts and the full text of publications; extracted data; and assessed risk of bias. Any disagreements were resolved by consensus. Pooled results were reported as odds ratio (OR) and 95% confidence interval (95% CI) by the Mantel-Haenszel method. MAIN RESULTS Only two trials involving 230 women met the inclusion criteria. Both studies had a moderate risk of bias. Oral cabergoline, 0.5 mg daily, was given as an intervention and compared with a matched placebo. A statistically significant reduction in OHSS was observed in the cabergoline treated group (OR 0.40, 95% CI 0.20 to 0.77; 2 RCTs, 230 women) with a number needed to treat (NTT) of 7. There was a statistically significant difference in the incidence of moderate OHSS, favouring cabergoline (OR 0.38, 95% CI 0.19 to 0.78; 2 RCTs, 230 women) but not in severe OHSS (OR 0.77, 95% CI 0.24 to 2.45; 2 RCTs, 230 women). There was no significant difference in the clinical pregnancy rate (OR 0.94, 95% CI 0.56 to 1.59; 2 RCTs, 230 women), miscarriage rate (OR 0.31, 95% CI 0.03 to 3.07; 1 RCT, 163 women) or any other adverse effects of the treatment (OR 2.07, 95% CI 0.56 to 7.70; 1 RCT, 67 women). However, no data on multiple pregnancy rate or live birth rate were reported in either trial. AUTHORS' CONCLUSIONS Cabergoline appears to reduce the risk of OHSS in high-risk women, especially for moderate OHSS. The use of cabergoline does not affect the pregnancy outcome (clinical pregnancy rate, miscarriage rate), nor is there an increased risk of adverse events. Further research should consider the risk of administering cabergoline and the comparison between cabergoline and established treatments (such as intravenous albumin and coasting). Large, well-designed and well-executed RCTs that involve more clinical endpoints are necessary to further evaluate the role of cabergoline in OHSS prevention.
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Affiliation(s)
- Huilin Tang
- Department of Pharmacy, Therapeutic Drug Monitoring and Clinical Toxicology Center of Peking University, Peking UniversityThird Hospital, Beijing, China.
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