Abstract
Cabergoline, a dopamine receptor-2 agonist, is suggested to prevent ovarian hyperstimulation
syndrome (OHSS) during ovarian stimulation. The aim of this study was to evaluate
the influence of different timing of cabergoline administration on clinical outcome
among patients at risk of developing OHSS. Among infertile women undergoing IVF treatment
at risk of developing OHSS, 206 were enrolled in this study. The subjects were randomly
allocated into two groups, i.e. the study group (n = 100) receiving cabergoline beginning on the day of human chorionic gonadotrophin (HCG)
injection and the control group (n = 100) receiving cabergoline starting on the day of oocyte retrieval. Oocyte metaphase-II
rate, fertilization rate, clinical outcome and incidence of severe OHSS were compared
between the two groups. There were no significant differences in oocyte metaphase-II
rate (0.86 ± 0.16 versus 0.85 ± 0.15) or fertilization rate (0.79 ± 0.22 versus 0.76 ± 0.20) or in the incidence of OHSS between two groups. Similarly, there were no significant
differences in implantation or clinical pregnancy rate between the two groups. Cabergoline
can be administered as soon as HCG injection to prevent early OHSS, without adverse
effects on oocyte maturation, fertilization rate and clinical outcome.
Cabergoline, a dopamine receptor-2 agonist, is suggested to prevent ovarian hyperstimulation
syndrome (OHSS) during ovarian stimulation. Nevertheless, the most suitable timing
of cabergoline administration has not yet been studied. The aim of this study was
to evaluate the influence of different timing of cabergoline administration on final
oocyte maturation, fertilization rate and clinical outcome among patients at risk
of developing OHSS. Among infertile women undergoing IVF treatment at risk of developing
OHSS, 206 were enrolled in this study. The subjects were randomly allocated into two
groups, i.e. the study group (n = 100) receiving cabergoline beginning on the day of human chorionic gonadotrophin (HCG)
injection and the control group (n = 100) receiving cabergoline starting on the day of oocyte retrieval. Oocyte metaphase
II rate, fertilization rate, clinical outcome and incidence of severe OHSS were compared
between the two groups. There were no significant differences in oocyte metaphase
II rate (0.86 ± 0.16 versus 0.85 ± 0.15) or fertilization rate (0.79 ± 0.22 versus 0.76 ± 0.20) or in the incidence of OHSS (3/100 versus 1/100) between the control and study
groups. Similarly, there were no significant differences in implantation rate (36.6%
versus 34.0%) or clinical pregnancy rate (54.0% versus 51.0%) between the two groups.
Among women at high risk of OHSS, cabergoline can be administered as soon as the HCG
injection to prevent early OHSS, without adverse effects on oocyte maturation, fertilization
rate and clinical outcome.
Keywords
To read this article in full you will need to make a payment
Subscribe to Reproductive BioMedicine Online
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures.Hum. Reprod. Update. 2003; 9: 275-289
- Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction.J. Clin. Endocrinol. Metab. 2007; 92: 2931-2937
- Regulation of vascular permeability by vascular endothelial growth factors.Vascul. Pharmacol. 2002; 39: 225-237
- The effect of VEGF on the temporal-spatial change of alpha-tubulin and cortical granules of ovine oocytes matured in vitro.Anim. Reprod. Sci. 2009; 113: 236-250
- Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study.Reprod. Biomed. Online. 2008; 17: 751-755
- Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review.Hum. Reprod. Update. 2002; 8: 559-577
- Review of the role of the plasminogen activator system and vascular endothelial growth factor in subfertility.Fertil. Steril. 2008; 90: 2340-2350
- Analysis of biological effects and signaling properties of Flt-1 (VEGFR-1) and KDR (VEGFR-2). A reassessment using novel receptor-specific vascular endothelial growth factor mutants.J. Biol. Chem. 2001; 276: 3222-3230
- Ovarian hyperstimulation syndrome: an update review.Obstet. Gynecol. Surv. 1989; 44: 430-440
- Administration of moderate and high doses of gonadotropins to female rats increases ovarian vascular endothelial growth factor (VEGF) and VEGF receptor-2 expression that is associated to vascular hyperpermeability.Biol. Reprod. 2003; 68: 2164-2171
- Low-dose dopamine agonist administration blocks vascular endothelial growth factor (VEGF)-mediated vascular hyperpermeability without altering VEGF receptor 2-dependent luteal angiogenesis in a rat ovarian hyperstimulation model.Endocrinology. 2006; 147: 5400-5411
- IVF versus ICSI in sibling oocytes from patients with polycystic ovarian syndrome: a randomized controlled trial.Hum. Reprod. 2005; 20: 1261-1265
- Trials to assess equivalence: the importance of rigorous methods.BMJ. 1996; 313: 36-39
- Role of vascular endothelial growth factor in ovarian physiology – an overview.Reprod. Biol. 2005; 5: 111-136
- The pathogenesis of the ovarian hyperstimulation syndrome.N. Engl. J. Med. 2003; 349: 729-732
- Coasting – what is the best formula?.Hum. Reprod. 2003; 18: 937-940
- Statistical principles for clinical trials (ICH E9): an introductory note on an international guideline.Stat. Med. 1999; 18: 1903-1942
- Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles.J. Assist. Reprod. Genet. 2007; 24: 331-336
- Effect of vascular endothelial growth factor on maturation, fertilization and developmental competence of bovine oocytes.J. Vet. Med. Sci. 2002; 64: 803-806
- Can we eliminate severe ovarian hyperstimulation syndrome? Comment I.Hum. Reprod. 2005; 20 (author reply 2369–2370): 2368-2369
- Cabergoline: a safe, easy, cheap, and effective drug for prevention/treatment of ovarian hyperstimulation syndrome?.Eur. J. Obstet. Gynecol. Reprod. Biol. 2005; 122: 127-128
- Distinction between early and late ovarian hyperstimulation syndrome.Fertil. Steril. 2000; 73: 901-907
- Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome.Lancet. 1994; 344: 235-236
- Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles.Fertil. Steril. 2006; 85: 112-120
- Etiology of OHSS and use of dopamine agonists.Fertil. Steril. 2012; 97: 517-522
- Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome.Hum. Reprod. Update. 2008; 14: 321-333
- Cabergoline for preventing ovarian hyperstimulation syndrome.Cochrane Database Syst. Rev. 2012; 2: CD008605
- High fertilization and implantation rates after intracytoplasmic sperm injection.Hum. Reprod. 1993; 8: 1061-1066
- Human chorionic gonadotropin-induced ovarian hyperstimulation syndrome is associated with up-regulation of vascular endothelial growth factor.J. Clin. Endocrinol. Metab. 2002; 87: 3300-3308
- Vascular endothelial growth factor receptor 2-mediated angiogenesis is essential for gonadotropin-dependent follicle development.J. Clin. Invest. 2003; 112: 659-669
Article Info
Publication History
Published online: March 25, 2013
Accepted:
March 12,
2013
Received in revised form:
March 6,
2013
Received:
October 22,
2012
Declaration: The authors report no financial or commercial conflicts of interest.Footnotes
Kok-Min Seow received his MD degree from the National Yang-Ming University, Taiwan in 1996. After completing residency training at the Shin-Kong Wu Ho-Su Memorial Hospital, he served as an attending physician at the Shin-Kong Wu Ho-Su Memorial Hospital. In 2007, he obtained his PhD degree from the department of clinical medicine, National Yang-Ming University. He is also an assistant professor at the school of medicine, National Yang-Ming University. His clinical interests include prenatal ultrasound diagnosis and laparoscopic surgery and his research interest is insulin resistance in polycystic ovary syndrome.
Identification
Copyright
© 2013 Reproductive Healthcare Ltd. Published by Elsevier Inc. All rights reserved.
