Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Gürgan, Timur; Demi̇rol, Aygül; Güven, Süleyman; Benkhalifa, Moncef; Girgin, B.; Li, Tin‐Chiu

doi:10.1016/j.fertnstert.2011.04.094

Cited by 26 publications

(18 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This trial tested the interaction of adding oral cabergoline as VEGF receptor antagonist with calcium infusion as VEGF lowering drug and found a significant lowering effect of this combination on overall OHSS incidence [overall OHSS 87.2%) 110/) in CI+ versus 1816.3%) 110/) in CI-with ∆pp = -9.1% at 95% CI of (-0.49, -17.8), P = 0.036] as well non significant lowering effect on moderate (p = 0.3) and severe (p = 0.3) OHSS. These overall reduced of OHSS incidence in high risky women for OHSS was achieved without a reduction in implantation rate, pregnancy rate, live birth rate of fresh embryo transfer, similar results were reported from trials of calcium infusion compared to placebo [12,19,40] and when compared calcium with oral cabergoline [23] . Women included in this study were compared to subgroup with irregular cycles treated with LAP and triggered with HCG in Toftager et al trial, where they reported an incidence of severe OHSS to be 916.7%) 54/) in comparing two women at lower risk for OHSS with the same protocol of COH which is 35/ 441(7.9%) when there is no OHSS preventive step was done.…”

Section: Discussionsupporting

confidence: 72%

“…In calcium infusion plus oral cabergoline group (CI+) one tablet 0.5 mg oral cabergoline taken daily for eight days starting at night of HCG triggering [9,17,18] (cabergamoun 0.5 mg, AMON pharmaceutical Co, SAE, El-Obur City, Cairo, Egypt) and 10 ml IV 10% calcium gluconate in 200 ml, 0.9% saline solution were given on day of ovum pick up (OPU) over 30 minutes and this is repeated on day 1, 2 and 3 after OPU [12,19,23] . In calcium infusion alone group (CI-), Dummy tablets are taken at night of HCG administration and continuing for eight days as well as starting calcium infusion in the same fashion as stated in (CI+) group.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Sharafeldeen

2018

Evidence Based Women's Health Journal

View full text Add to dashboard Cite

Aim: To evaluate the interaction of adding oral cabergoline (OC) to calcium infusion as a preventive modality for ovarian hyperstimulation syndrome (OHSS) in risky women undergoing controlled ovarian hyperstimulation (COH) in context of in-vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI). Patients and Methods: This prospective, double-blind, randomized, placebo-controlled trial was conducted at Benha IVF center of Obstetrics and Gynecology Department of Benha University and Nour Al Hayah Fertility Center Between January 2015 and February 2016. 220 risky women for OHSS undergoing ICSI were included, they were randomized to 110 women received once daily OC for eight days, starting at HCG triggering and infusion of calcium gluconate 10 ml 10% in 200 ml 0.9% saline daily for 4 days beginning at ovum pick up (OPU), coined as calcium infusion plus group (CI+) and 110 women received only calcium infusion in the same fashion as in CI+ coined as calcium infusion minus group (CI-). The primary outcome was the overall incidence of OHSS while the secondary issues were OHSS types and grades as well as other ICSI outcomes. Results: The incidence of overall OHSS was significantly lower in calcium infusion plus oral cabergoline (CI+) group compared to calcium infusion alone (CI-) group [8/110(7.2%) in CI+ versus 18/110 (16.3%) in CI-with difference in proportion percentage point (∆PP)=-9.1%, 95% CI: -0.49, -17.4; P = 0.036]. Despite the incidence of moderate and severe OHSS was lower in CI+ than in CI-, this difference didn't reach the significance level (2.7% vs 5.4%; p = 0.3) and (0.9% versus 2.7%; ), respectively. The other COH and ICSI outcomes didn't show any statistically significant differences. Conclusion: Adding oral cabergoline to calcium infusion is effective than calcium infusion alone in the reduction of overall OHSS incidence as well as its severity at comparable pregnancy outcomes.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Sharafeldeen

2018

Evidence Based Women's Health Journal

View full text Add to dashboard Cite

show abstract

“…[22] Gurgan et al in their retrospective study also researched and found that calcium infusion successfully prevents the development of severe OHSS and significantly decreases OHSS occurrence rates without any major adverse effect when used for high-risk patients such as those with polycystic ovary syndrome (PCOS). [23] With the background of success, demonstrated by both Cb2 and calcium for the prevention of this iatrogenic complication, we compared their efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…As a consequence, the stimulatory effect of angiotensin II on VEGF production is ameliorated. [23] All these pathophysiologic mechanisms (decreased synthesis of renin, angiotensin II and VEGF) which occurs from calcium gluconate infusion, therefore prevents the development of OHSS in such high risk patients undergoing ART cycles. Our results also document that calcium infusion can effectively prevent the development of severe OHSS and decreases OHSS occurrence rates without any major adverse affect when used for high-risk patients such as those with PCOS.…”

Section: Discussionmentioning

confidence: 99%

Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome

Naredi¹,

Karunakaran²

2013

J Hum Reprod Sci

View full text Add to dashboard Cite

BACKGROUND:Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life-threatening disease process, which may occur in healthy young women undergoing controlled ovarian hyperstimulation for assisted reproduction. As the treatment is largely empirical, prevention forms the mainstay of management.OBJECTIVE:The present study was aimed to evaluate the effectiveness of intravenous (IV) calcium gluconate infusion in comparison to the dopamine agonist cabergoline (Cb2) in preventing OHSS in high risk patients undergoing assisted reproductive technique cycles.MATERIALS AND METHODS:It was a comparative study wherein the 202 high risk patients undergoing in vitro-fertilization over a period of 18 months after meeting the strict inclusion and the exclusion criteria, were randomly divided into two groups (98 subjects in Group I and 104 in Group II). Women in Group I were administered IV calcium gluconate while the remaining 104 received the dopamine agonist Cb2. The 104 patients belonging to Group II were started Cb2 0.5 mg/day from the day of ovulation trigger and continued until the next 8 days while the 98 high risk patients from Group I were infused with 10 ml of 10% calcium gluconate solution in 200 ml physiologic saline within 30 min of ovum pick up and continued thereafter on day 1, day 2 and day 3.RESULTS:The occurrence of OHSS was seen in only nine patients (in the calcium infusion group, when compared with 16 patients (9.2% vs. 15.4%) who were administered Cb2, but it was not statistically significant. However, only one had severe OHSS in Group I, whereas two women were diagnosed as severe OHSS belonging to the Cb2 arm.CONCLUSION:Our results document that calcium infusion can effectively prevent severe OHSS and decreases OHSS occurrence rates when used for high-risk patients, but does not suggest its superiority over Cb2. With comparable success rates, either of them can be employed as a preventive strategy for OHSS.

show abstract

“…Gürgan et al (43) reported that intravenous calcium infusion might prevent the development of OHSS by blocking the renin-angiotensin system, and thus causing the VEGF levels to decrease.…”

Section: Introductionmentioning

confidence: 99%

Problems and Complications During the Treatment of Infertility in Women with Polycystic Ovary Syndrome

Kalem

Gürgan

2016

Gynecol Obstet Reprod Med

View full text Add to dashboard Cite

Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder existing in women in their reproductive years and it is one of the most evaluated and discussed subjects of reproductive medicine with regard to its diagnosis and treatment.Patients with PCOS constitute the most difficult population in the management of infertility. The factors that increase the success rates in the treatment of PCOS infertility are: pretreatment changes in life style, dietetic and psychological support, a detailed evaluation of the couple and the appropriate selection of the treatment protocol, a wide-spectrum approach to maintaining ovarian and endometrial synchronization in the management of the cycle, and well-developed laboratory conditions to support embryonic quality. However, even if these conditions are provided, OHSS, cancellations of the cycle, poor oocyte, and embryo qualities, unsuccessful fertilization and implantation, chromosomal abnormalities and early losses may still be experienced.

show abstract

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

Cited by 26 publications

References 27 publications

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Calcium infusion plus or minus cabergoline for prevention of ovarian hyperstimulation syndrome: Randomized double-blind placebo-controlled trial

Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome

Problems and Complications During the Treatment of Infertility in Women with Polycystic Ovary Syndrome

Contact Info

Product

Resources

About