Early onset of cabergoline therapy for prophylaxis from ovarian hyperstimulation syndrome (OHSS): A potentially safer and more effective protocol

Does the timing of cabergoline administration impact rates of ovarian hyperstimulation syndrome?

“…Although we found no improvement in reported discomfort or in the rates of severe OHSS with different timings of cabergoline, this may not be the case in hCG-triggered cycles. Given that the only proposed change to the protocol is the timing of cabergoline initiation, and because multiple studies have shown that earlier cabergoline administration has no negative impact on IVF outcomes [ 7 , 14 , 15 , 17 , 18 ], one could argue that there is no risk, and only potential benefit, to administering cabergoline starting at the time of trigger instead of following oocyte collection to reduce the rate of OHSS in moderate and high-risk patients. As demonstrated in the literature, our Trig group did not seem to have any negative outcomes related to oocyte collection and embryo development when compared to the group that received cabergoline at the time of oocyte collection.…”

“…This raises a concern as to whether giving cabergoline to prevent OHSS could inadvertently have a negative impact on oocyte maturation, endometrial angiogenesis, implantation, and pregnancy rates [ 8 ], especially if administered before oocyte retrieval. However, hCG, which is often used to trigger ovulation in IVF cycles, is known to increase the VEGF protein level by increasing VEGF mRNA concentrations in ovarian granulosa cells [ 17 ]. If, in an attempt to avoid potential detrimental effects on the developing follicles and subsequent IVF outcomes, we delay cabergoline administration until the day of oocyte retrieval instead of initiating treatment on the day of hCG trigger (36 hours earlier), it is concerning that cabergoline may be less effective in preventing OHSS.…”

“…The OHSS rate was a secondary outcome in this study, but cabergoline seemed to have the same effect on lowering rates of moderate and severe OHSS in this study, regardless of when it was initiated. Gaafar et al [ 17 ] conducted a case series study involving 126 patients in 2019, wherein cabergoline was administered before the hCG trigger (when the leading follicle reached a size of 15 mm). They found that early administration of cabergoline was effective and safe in preventing early OHSS, and that it did not compromise pregnancy rates, although the study had no control group [ 17 ].…”

“…Gaafar et al [ 17 ] conducted a case series study involving 126 patients in 2019, wherein cabergoline was administered before the hCG trigger (when the leading follicle reached a size of 15 mm). They found that early administration of cabergoline was effective and safe in preventing early OHSS, and that it did not compromise pregnancy rates, although the study had no control group [ 17 ]. The results of these studies would suggest that administering cabergoline at the time of hCG trigger or earlier does not adversely affect IVF outcomes in humans.…”

Ovarian Hyperstimulation: Diagnosis, Prevention, and Management

“…62 In accordance with this evidence, a recent study found that starting cabergoline administration when the size of the leading follicle reached 15 mm is a safer approach. 63 In patients at higher OHSS risk and with the clinical indication to freeze-all following oocyte retrieval, our center's protocol includes seven days of vaginal cabergoline, starting from the day of the procedure. Although vaginal administration is currently off label, it has been used for the treatment of prolactinoma since 1996 64 to reduce oral cabergoline side effects.…”