Comparison of Bromocriptine and Hydroxyethyl Starch for Reducing Ohss in in Vitro Fertilization Patients: A Retrospective Study

Abstract

Background: The ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication associated with controlled ovarian hyperstimulation (COS) during assisted reproductive technology (ART) treatment, and effective preventive measures are urgently needed. The dopamine agonist can mitigate OHSS incidence through a decreased vascular permeability via reduced vascular endothelial growth factor (VEGF) production. This study evaluated the clinical effectiveness of bromocriptine, an alternative DA, for prevention of OHSS in high risk women.Methods: The retrospective study population consisted of women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles with GnRH antagonist protocols, at risk of OHSS. The study group included 52 women given 2.5 mg bromocriptine daily by rectal insertion for 5 days beginning on the day of oocyte retrieval; the control group included 52 women given 500 ml intravenous (I.V.) hydroxyethyl starch (HES) daily for 5 days also beginning on the day of oocyte retrieval. The outcomes of ovarian stimulation, incidence and severity of OHSS, blood-related indicators, biochemical indicators (liver and renal function), and coagulation and fibrinolytic activities were compared.Results: The groups were not significantly different in age, estradiol concentration on the day of human chorionic gonadotropin injection, or number of retrieved oocytes. The occurrence of mild (13.46% vs 15.48%) and moderate (7.69% vs 5.77%) OHSS were not significantly different between bromocriptine and HES groups (P>0.05). No cases of severe or late OHSS were recorded in either group. Only hemocratin levels were significantly higher and activated partial thromboplastin time was significantly lower in the bromocriptine group (P<0.05) compared to the HES group on Day 5 after oocyte retrieval. No difference in liver or renal function was found between groups.Conclusions: Prophylactic rectal administration of bromocriptine was as effective as I.V. HES for prevention of OHSS.