Cabergoline decreases the risk of ovarian hyperstimulation syndrome and has no effect on pregnancy rate during in vitro fertilization

Abstract

OBJECTIVE: To determine if cabergoline decreases the risk of ovarian hyperstimulation syndrome(OHSS) in patients undergoing in vitro fertilization(IVF), without affecting the pregnancy outcome. DESIGN: A retrospective case control of high risk patients given cabergoline for prevention of OHSS compared to young controls undergoing IVF. MATERIALS AND METHODS: Patients undergoing IVF at a large university affiliated practice from January 2004 to April 2007 were evaluated. Starting in 2006, patients at high risk for OHSS were treated with cabergoline 0.5mg on Day 0, Day 3 and Day 6. Prophylactic treatment was at the discretion of the attending physician at time of oocyte retrieval. IVF patients age 30-35 were chosen as pregancy rate controls, because of their expected good ovarian response. Statistical analysis was performed using Chi-Square analysis. RESULTS: The study group consisted 74 cycles of hi-risk patients who were treated with cabergoline. 302 controls were chosen between the ages of 30-35. The study group had a mean age of 33, peak estradiol of 3472 pg/ml, 25% with a history of polycystic ovary syndrome, 10% with a history of previous OHSS. Clinical outcomes are shown in Table, demonstrating no change in pregnancy rates.Table 1Clinical Outcomes in the Cabergoline Group Compared to ControlsOutcome MeasureCabergolineControlsp ValueAverage # Oocytes24150.0001∗P< 0.05 as significant.# Transfers64284Average # Transferred2.02.20.660Implantation Rate33%34%0.7464Biochemical Pregnancy Rate59%57%0.763Clinical Pregnancy Rate50%55%0.5276∗ P< 0.05 as significant. Open table in a new tab Table 2 shows a 42% decrease in the number of office visits for OHSS evaluation during years that cabergoline was used. The number of IVF cycles during those years was used to correct for variation in clinical volume.Table 2Number of Office Visits and Admissions for OHSS in the Years Preceding and After Cabergoline Use200420052006- + Cabergoline1-4/2007 + CabergolineOHSS Visits1261206016IVF Cycles905934783200# Admissions173 (Not on cabergoline)1 (On cabergoline)∗P<0.0001 comparing # OHSS visits/# IVF cycles in years before and after cabergoline use. Open table in a new tab ∗P<0.0001 comparing # OHSS visits/# IVF cycles in years before and after cabergoline use. CONCLUSIONS: Cabergoline is a safe and well tolerated medication that decreased the frequency and severity of OHSS after IVF in Hi-Risk patients. The high pregnancy rate observed was similar to other young women, suggesting no signficant detriment to pregnancy rates or outcomes.