How to avoid ovarian hyperstimulation syndrome: a new indication for dopamine agonists

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a significant iatrogenic complication in assisted reproduction.
• Despite advances in ART, understanding and managing OHSS has lagged until recently.

Purpose of the Study:

• To review recent advancements in the understanding, prediction, and prevention of OHSS.
• To highlight novel treatment strategies for mitigating OHSS effects.

Main Methods:

• Review of recent literature on OHSS pathophysiology and management.
• Identification of key molecular players like vascular endothelial growth factor (VEGF).
• Evaluation of emerging treatment options including pharmacological interventions.

Main Results:

• Anti-Müllerian hormone (AMH) shows potential as a risk predictor.
• Effective prevention strategies include coasting and GnRH antagonist/agonist protocols.
• VEGF is identified as crucial in OHSS-related vascular permeability.
• Cabergoline effectively reduces VEGF-mediated permeability without impacting fertility outcomes.

Conclusions:

• Improved understanding of OHSS pathophysiology is leading to better prediction and prevention.
• Novel treatments, including cabergoline, complement existing strategies like in-vitro maturation and oocyte vitrification.
• Further research aims to enhance patient selection and minimize OHSS incidence and severity.