The effect of cabergoline on folicular microenviroment profile in patients with high risk of OHSS

Abstract

OBJECTIVE: Dopamine agonists have been proposed as a prophylactic treatment for ovarian hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles, however the possible mechanism of action has not been known. The main aim of this study is to investigate the effect cabergoline on the follicular fluid hormone levels. DESIGN: In this prospective age and body mass index (BMI) matched case control study, a total of 41 women with PCOS diagnosed and treated for primary infertility at the IVF center were included. Main inclusion criteria were development of more than 14 leading follicles larger than 10 mm and serum estradiol more than 3000 pg/ml at the end of ovulation induction with long downregulation protocol. The patients in study (15 patients) was administered cabergoline (started on day of HCG) for prevention of OHSS, the patients (n=26) in the control group had manipulation for prevention of OHSS and age-, BMI-matched with the study group. Follicular fluid samples were collected in whole group, on day of oocyte pick-up. MATERIALS AND METHODS: Four markers markers (Antimullerian hormone (AMH), Inhibin B, Hepatocyte growth factor (HGF), Insulin like growth factor-1 (IGF-1) with commercially available ELISA kits were studied in follicular fluid samples. Follicular fluid hormones concentrations were compared between the study and control groups using a Mann–Whitney U test. RESULTS: In the study group follicular fluid AMH (2.96 ± 1.27 vs. 1.91 ± 0.64, p=0.005), Inhibin B (1339.47 ± 198.56 vs. 1200.09 ± 133.64, p=0.021), HGF (5623.21 ± 2411.09 vs. 3787.42 ± 2269.89, p=0.021) and IGF-1 (298.60 ± 37.80 vs. 219.90 ± 71.40, p<0.001) concentrations were significantly decreased compared with control group. No cases of OHSS was observed in study group ,while the OHSS rate was 15/26 in control group. There was no statistically significant difference in clinical pregnancy rates between two groups. CONCLUSION: Cabergolin prevent OHSS in high risk patients by disrupting folliculer fluid hormone microenviroment.