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

Abstract

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.

Comprehensive Management of Polycystic Ovarian Syndrome and Secondary Infertility: Optimizing Fertility Outcomes

“…The extended GnRH agonist regimen was used to stimulate 180 individuals who were at high risk of having OHSS and were randomly assigned in a ratio of one to one to the cabergoline group and the calcium gluconate group, and it was discovered that calcium gluconate was more advantageous for preventing OHSS. There are other articles comparing calcium gluconate, cabergoline, and other medications for preventing OHSS [ 14 ], but based on our research, none of them demonstrated the combined effect of calcium gluconate and cabergoline, with the exception of one article that contrasted the combined effects of these two with calcium gluconate infusion alone and found that the combined effect was beneficial [ 15 ]. We made the decision to administer the patient a cabergoline tablet and a calcium gluconate (10%) intravenous infusion together (starting on the day of OPU, for three days) since OHSS is more severe in PCOS women receiving IVF/ICSI treatment because of increased arterial permeability, which causes proteinaceous fluid to flow into third spaces [ 16 ].…”