Efficacy of cabergoline in the prevention of severe ovarian hyperstimulation syndrome in high-risk women undergoing assisted reproductive technology treatment

Authors

  • Praveena Palani Department of Reproductive Medicine, CIMAR, Edappal Hospitals (P)Ltd, Kerala, India
  • Vijayan Sharmila Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
  • Thirunavukkarasu Arun Babu Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
  • Gopinathan K. K. CIMAR, Edappal Hospitals, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20221927

Keywords:

Cabergoline, OHSS, ART

Abstract

Background: Ovarian hyperstimulation syndrome (OHSS) is a severe and potentially life-threatening complication of controlled ovarian stimulation (COH). Cabergoline has been tried as a preventive measure for OHSS in high-risk women undergoing assisted reproductive technology (ART) treatment. Our study was done to assess the effectiveness of cabergoline in preventing severe OHSS in high-risk women undergoing ART treatment.

Methods: This is a prospective interventional study done among patients undergoing ART with serum estradiol levels >4000 pg/ml on the day of hCG administration were included in the study. Women undergoing ART with serum estradiol levels >4000 pg/ml on the day of hCG administration, were assigned into two groups using random number allocation. Women in treatment group received cabergoline 0.5 mg daily for 8 days from the day of hCG administration and control group did not receive Cabergoline therapy. The patients in both groups were followed up to study the incidence and severity of OHSS in that treatment cycle

Results: The incidence of severe OHSS was two in each group with clinical and ultrasound evidence of ascites. Embryo transfer was cancelled in one patient in each group in view of severe OHSS with tense ascites. One patient in treatment group had severe OHSS that needed peritoneal fluid tapping with fresh frozen plasma administration. Life threatening complications were not encountered in any of the patients with high risk for OHSS included in the study.

Conclusions: Cabergoline did not prevent the incidence of severe OHSS in patients at high risk for OHSS in our study. Large randomized trials would be needed to confirm the findings of our study.

References

Gardner DK, Weissman A, Howles CM, Shoham Z. Textbook of Assisted Reproductive Technologies. Laboratory and Clinical Perspectives.3rd edition. Informa healthcare. 2004;760-9.

Rizk B. Ovarian hyperstimulation syndrome. Epidemiology, Pathophysiology, Prevention and Management. Cambridge University Press. 2006:3-6.

Delvigne A, Rozenberg S. A systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in in vitro fertilisation patients. Hum Reprod Update. 2002;8:291-6.s

Grbavac I, Ljiljak D, Krunoslav K. Prevention and Treatment of Ovarian Hyperstimulation Syndrome, Advances in Embryo Transfer, Dr. Bin Wu (Ed.). 2012.

Aboulghar M, Evers JLH, Al-Inany HG. Intra-venous albumin for preventing severe ovarian hyperstimulation syndrome. Cochrane Database of Systematic Reviews. 2002;2:CD001302.

Kol S, Solt I. GnRH agonist for triggering final oocyte maturation in patients at risk of ovarian hyperstimulation syndrome: still a controversy? J Assist Reprod Genet 2008;25:63-6.

Lanzendorf SE. Developmental potential of in vitro- and in vivomatured human oocytes collected from stimulated and unstimulated ovaries. FertilSteril. 2006;85:836-7.

Suikkari AM. In-vitro maturation: its role in fertility treatment. Curr Op In Obstet Gynecol. 2008;20:242-8.

Edwards RG. IVF, IVM, natural cycle IVF, minimal stimulation IVF-time for a rethink. Reproduct Biomed Online 2007;15:106-19.

Youssef MA, Wely MV, Hassan MA, Al-Inany HG, Mochtar M, Khattab S et al. Can dopamine agonists reduce theincidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Human Reproduct Update. 2010;16:459-66.

Youseef MA. OHSS: Is there any optimal preventive measure? Kasr Al-Aini J Obstetr Gynecol. 2012;3:2.

Hosseni MA, Aleyasin A, Mahdavi A, Nezami R, Safdaian L, FallahiP.The Effectiveness of Cabergoline for the Preventionof Ovarian Hyperstimulation Syndrome. Iran J Med Sci. 2011;36:207-12.

Fiedler K, Ezcurra D. Predicting and preventing ovarianhyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reproductive Biology and Endocrinology 2012, 10:32.

Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome.Cochrane Database of Systematic Rev. 2012;2:CD008605.

Basu S, Nagy JA, Pal. The neurotransmitter dopamine inhibits angiogenesis induced by vascular permeability factor/vascular endothelial growth factor. Nature Med. 2001;7:569-74.

Alvarez C, Marti-Bonmati L, Novella-Maestre E, SanzR,Gomez R, Fernandez-Sanchez M et al. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. J Clin Endocrinol Metabo. 2007;92:2931-7.

Verhelst J, Abs R, Maiter D. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J ClinEndocrinol Metab. 1999;84,2518-2522.

Alvarez C, Alonso-Muriel I, Garcia G, Crespo J, Bellver J, Simon C et al. Implantation is apparently unaffected by the dopamine agonist cabergoline when administered to prevent ovarian hyperstimulation syndrome(OHSS) in women undergoing ART: a pilot study. Hum Reprod. 2007;22:3210-4

Ricci E, Parazzini F, Motta T, Ferrari CI, Colao A, Clavenna A et al. Pregnancy outcome after cabergoline treatment in early weeks of gestation. Reprod Toxicol. 2002;16:791-3.

Carizza C, Abdelmassih V, Abdelmassih S, Ravizzini P, Salgueiro L, Salgueiro PT et al. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reproductive Biomedicine Online. 2008;17:751-5.

Salah Edeen AMR, Alhelou YM. Can cabergoline prevent ovarian hyperstimulation syndrome in PCO patients undergoing gonadotropin stimulation? Comparative study with prednisolone. Abstracts of the25th Annual Meeting of ESHRE, Amsterdam, The Netherlands. 2009.

Shaltout A, Shohayeb A, Eid M. Role of cabergoline in preventing ovarian hyperstimulation syndrome in high-risk intracytoplasmic sperm injection (ICSI) patients and effect on outcome. 25th Annual Meeting of ESHRE, Amsterdam, The Netherlands. 2009.

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Published

2022-07-27

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Original Research Articles