The Influence of Cabergoline and Coasting in Prevention of the Ovarian Hyperstimulation Syndrome in Patients Undergoing IVF/ICSI-ET Treatment: A Systematic Review and Meta-Analysis

Abstract

Objective: To compare the effectiveness of two methods in preventing ovarian hyperstimulation syndrome (OHSS) with cabergoline and coasting. Design: Systematic review and meta-analysis of randomized clinical trials (RCTs). Patients: Women were considered as have risk of OHSS undergoing fertility treatment. Interventions: Cabergoline, coasting. Result: There were included five RCT studies. The clinical pregnancy rate was no significantly difference between two groups (RR 1.22, 95% CI [0.86, 1.71]), implantation rate (RR 1.00, 95% CI [0.75, 1.32]), severe OHSS (RR 0.93, 95% CI [0.38, 2.31]), fertilization rate (SMD 0.70, 95% CI [−0.10, 1.50]), number of oocytes retrieved (SMD 0.80, 95% CI [0.30, 1.30]), number of embryo transfer (SMD-0.04, 95% CI [−0.24, 0.17]), E 2 value on the day of HCG injection (SMD 0.21, 95% CI [−0.25, 0.68]), number of MII oocytes (SMD 0.71, 95% CI [0.32, 1.11]), abortion rate (RR 0.61, 95% CI [0.21, 1.83]), number of follicles > 17 mm on day of HCG (SMD-0.01, 95% CI [−0.26, 0.24]), number of follicles 15-17 mm on day of HCG (SMD −0.08, 95% CI [−0.33, 0.17]), number of follicles 10-14 mm on day of HCG (SMD −0.06, 95% CI [−0.31, 0.19]). Conclusion: Both cabergoline and coasting prevent the occurrence of OHSS, but no statistically significant difference between them. Compared with coasting group, a daily dose of 0.5 mg cabergoline significantly increased the number of oocytes retrieved, MII oocytes, and fertilization rate, but decreased the abortion rate.

Cabergolina en El Tratamiento Del Síndrome De Hiperestimulación Ovárica: Una Revisión Actualizada.

“…Varios estudios han evaluado el uso de cabergolina en pacientes con SHO establecido, observando una disminución significativa en el tamaño de los ovarios y en la acumulación de líquido en la cavidad abdominal, dos características clínicas clave del SHO (6,11). Además, se ha reportado una mejoría en los síntomas como distensión abdominal, dolor pélvico y dificultad respiratoria en pacientes tratadas con cabergolina (12).…”

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“…Although clomiphene leads to ovulation in 80% of patients, about 50% of them become pregnant [6]. In these patients, due to the hypersensitivity of the ovaries to gonadotropins, there is a risk of multiple pregnancies (7 to 10% of clomiphene use can be associated with twins) and ovarian hyperstimulation syndrome (OHSS) [7,8]. Letrozole, an aromatase inhibitor, is now used as a choice to induce ovulation.…”