Cabergoline successfully prevented the incidence of severe OHSS

Abstract

Ovarian hyperstimulation syndrome (OHSS) is one of serious complications in ovarian stimulation for IVF/ICSI. Recently dopamine receptor agonist cabergoline is reported to prevent OHSS by modulationg VEGF receptor activity. We investigated if administration of cabergoline reduces the risk of severe OHSS on a retrospective basis. Retrospective controlled study. Sixty one women had prophylactic intervention of cabergoline. They had controlled ovarian hyperstimulation for IVF or ICSI. Serum estrogen level in them on the HCG day showed more than 3500 pg/ml, so they had all embryos frozen instead of fresh transfer after OPU. Cabergoline 0.5mg was administered every two days 3 times from the OPU day. Total of 126 control cases had same treatment as intervention group other than cabergoline administration. Two group's characteristics are matched in age, number of picked up eggs, serum E2 level on the HCG day, and serum AMH. Both groups had screening tests of CBC and ultrasound monitoring on the 7th day after OPU. The grade of OHSS is classified in 3 groups as mild, moderate, or severe. The classification was according to patients' complaints, ovarian sizes, volume of ascites, and CBC findings. The volumes of ovaries are estimated by (longest diameter) x (shortest diameter)2. We analyzed the data using Fisher's exact test. The average age, number of obtained eggs by OPU, serum E2 (pg/ml), and AMH (pmol/L) were 35.4 vs. 35.3, 18.8 vs. 19.2, 5358 vs. 5185, and 31.0 vs. 34.3 in cabergoline group (n = 61) vs. control group (n = 126) respectively. There was no statistical difference between them. The incidence of all OHSS was 60% vs. 75% (P=0.109). The combined incidence of moderate and severe OHSS was 9% vs. 24% (P=0.04). The volume of ovaries after OPU was significantly shrunk in cabergoline group (98.4cm3 vs. 138.3cm3 P=0.0039). Prophylactic administration of cabergoline reduced the incidence of moderate and severe OHSS, although total incidence of OHSS was not different.