Abstract
BackgroundPrevious studies have described the effects of different drugs in preventing ovarian hyperstimulation syndrome (OHSS). However, the efficacies of those drugs in preventing OHSS remain inconclusive.MethodsWe searched the PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. A network meta-analysis of randomized controlled trials (RCTs) was performed up to August 2021. We investigated the following drugs in our study: aspirin, albumin, metformin, calcium, cabergoline, quinagolide, letrozole, hydroxyethyl starch (HES), and glucocorticoids. The primary outcome was the incidence rate of moderate-to-severe OHSS, with the results presented as risk ratios (RRs) with 95% confidence intervals (CIs).ResultsThe incidence of moderate-to-severe OHSS was significantly reduced by calcium administration (risk ratios [RR] 0.14, 95% confidence interval [CI]: 0.04, 0.46) (grade: high), HES (RR 0.25, 95% CI 0.07, 0.73) (grade: high), and cabergoline (RR 0.43, 95% CI 0.24, 0.71) (grade: moderate). The surface under the cumulative ranking curve (SUCRA) indicated that calcium (SUCRA, 92.4%) was the most effective intervention for preventing moderate-to-severe OHSS. These drugs were safe and did not affect clinical pregnancy, miscarriage, or live birth rates.ConclusionCalcium, HES, and cabergoline could effectively and safely prevent moderate-to-severe OHSS, with calcium as the most effective intervention.
Highlights
Ovarian hyperstimulation syndrome (OHSS) is a common complication of controlled ovulation stimulation (COS)
The primary outcome was the incidence rate of moderate-to-severe OHSS, with the results presented as risk ratios (RRs) with 95% confidence intervals (CIs)
The incidence of moderate-to-severe OHSS was significantly reduced by calcium administration, hydroxyethyl starch (HES) (RR 0.25, 95% CI 0.07, 0.73), and cabergoline (RR 0.43, 95% CI 0.24, 0.71)
Summary
Ovarian hyperstimulation syndrome (OHSS) is a common complication of controlled ovulation stimulation (COS). A review reported that the incidence of OHSS was 6%–11% for in vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) [1]. Women with polycystic ovarian syndrome (PCOS) are at higher risks of developing OHSS during COS. Our previous studies have shown that the incidence of OHSS is related to temperature and is higher in extreme climates (summer and winter) [3]. Mild OHSS is characterised by slightly enlarged ovaries. Moderate OHSS is characterised by abdominal distension, nausea, vomiting, and diarrhoea. OHSS prevention is a key clinical concern. Previous studies have described the effects of different drugs in preventing ovarian hyperstimulation syndrome (OHSS). The efficacies of those drugs in preventing OHSS remain inconclusive
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