Evaluation of a therapeutic combination to prevent ovarian hyperstimulation syndrome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253511Keywords:
Ovarian hyperstimulation syndrome, Cabergoline, Dopamine agonist, GnRH agonist trigger, In vitro fertilization, GnRH antagonist protocolAbstract
Background: Ovarian hyperstimulation syndrome (OHSS) remains a significant iatrogenic complication in assisted reproductive technology. Various strategies have been proposed to minimize its occurrence, particularly in high-risk patients. To evaluate the effectiveness of a combined preventive protocol including GnRH antagonist protocol, GnRH agonist trigger, dopamine agonist (cabergoline), calcium infusion, and a freeze-all strategy in reducing the incidence of OHSS without compromising IVF outcomes.
Methods: A comparative study was conducted on women undergoing IVF, divided into a study group receiving the combined protocol and a control group managed conventionally. Primary outcomes included stimulation parameters, incidence of OHSS, and biochemical pregnancy rates. Secondary outcomes assessed included the number of cumulus-oocyte complexes (COCs), mature oocytes (MII), and vitrified embryos.
Results: The study group showed significantly lower gonadotropin doses, with improved ovarian response reflected by higher numbers of COCs, MII oocytes, and vitrified embryos (p<0.05). Despite these improved biological outcomes, β-hCG positivity rates did not differ significantly between the two groups (24% vs. 26.5%; p=0.239). No cases of moderate or severe OHSS were observed in the study group.
Conclusions: The combined use of multiple evidence-based strategies appears effective in reducing the risk of OHSS while maintaining satisfactory IVF outcomes. This multifaceted approach may offer a safer stimulation pathway for high-risk patients without compromising pregnancy potential.
Metrics
References
Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 14 avr 2021;4(4):CD008605. DOI: https://doi.org/10.1002/14651858.CD008605.pub4
Kadoura S, Alhalabi M, Nattouf AH. Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis. Sci Rep. 2022;12(1):4456.
Mills G, Dahan MH. Gonadotropin releasing hormone (GnRH) antagonist administration to decrease the risk of ovarian hyperstimulation syndrome in GNRH agonist cycles triggered with human chorionic gonadotropin. Arch Gynecol Obstet. 2022;306(5):1731‑7. DOI: https://doi.org/10.1007/s00404-022-06717-8
Deepika K, Suvarna R, Sumi M, Snehal D, Arveen V, Anuja K, et al. HCG trigger versus GnRH agonist trigger in PCOS patients undergoing IVF cycles: frozen embryo transfer outcomes. JBRA Assist Reprod. 2021;25(1):48‑58. DOI: https://doi.org/10.5935/1518-0557.20200028
Wu D, Shi H, Yu Y, Yu T, Zhai J. Comparison of the Effectiveness of Various Medicines in the Prevention of Ovarian Hyperstimulation Syndrome: A Network Meta-Analysis of Randomized Controlled Trials. Frontiers in Endocrinology; 2022. Available at: https://www.frontiersin.org/articles/10.3389/fendo.2022.808517. Accessed 30 July 2023. DOI: https://doi.org/10.3389/fendo.2022.808517
Yanagihara Y, Tanaka A, Nagayoshi M, Tanaka I, Shinohara R, Fukushima F, et al. A modified GnRH antagonist method in combination with letrozole, cabergoline, and GnRH antagonist for PCOS: Safe and effective ovarian stimulation to treat PCOS and prevent OHSS. Reproductive Medicine and Biology. 2022;21(1):e12429. DOI: https://doi.org/10.1002/rmb2.12429
Rosenberg H, Rangwala S, Magee B. Syndrome d’hyperstimulation ovarienne. CMAJ. 2024;196(40):E1355-E1356. DOI: https://doi.org/10.1503/cmaj.240213-f
Kadoura S, Alhalabi M, Nattouf AH. Conventional GnRH antagonist protocols versus long GnRH agonist protocol in IVF/ICSI cycles of polycystic ovary syndrome women: a systematic review and meta-analysis. Sci Rep. 2022;12(1):4456. DOI: https://doi.org/10.1038/s41598-022-08400-z
Zhu J, Xing W, Li T, Lin H, Ou J. GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety. Frontiers in Endocrinology; 2022. Available at: https://www.frontiersin.org/articles/10.3389/fendo.2022.875779. Accessed 30 July 2023. DOI: https://doi.org/10.3389/fendo.2022.875779
Alvarez C, Bosch E, Melo MAB, Fernandez‐Sanches M, Munoz E A, Remohi J, et al. The dopamine agonist cabergoline prevents moderate‐severe early ovarian hyperstimulation syndrome (OHSS) in high‐risk ART patients. Human Reproduction. 2006;21:i96.
González VG, Triana AM, García IS, Nieto SO, Urrutia MC, García IC, et al. Dual trigger vs. Conventional trigger outcomes in In Vitro Fertilization. Systematic review and meta-analysis. JBRA Assist Reprod. 2023;27(1):112‑9. DOI: https://doi.org/10.5935/1518-0557.20220035
Gonen Y, Balakier H, Powell W, Casper RF. Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab. 1990;71:918–22. DOI: https://doi.org/10.1210/jcem-71-4-918
Zaat T, Zagers M, Mol F, Goddijn M, Wely M van, Mastenbroek S. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database of Systematic Reviews; 2021. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011184.pub3/full. Accessed 30 July 2023. DOI: https://doi.org/10.1002/14651858.CD011184.pub3
Naredi N, Karunakaran S. Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome. J Hum Reprod Sci. 2013;6(4):248-52. DOI: https://doi.org/10.4103/0974-1208.126293
Xia L, Cai L, Fan L, Tian L, Chen H, Xia L, Zhao Y. Comparison of efficacy, safety, and economy of recombinant and urinary follicle-stimulating hormone in women with a predicted normal response undergoing assisted reproductive technology. J Ovarian Res. 2025;18(1):208. DOI: https://doi.org/10.1186/s13048-025-01800-5
Downloads
Published
How to Cite
Issue
Section
