Dopamine agonists for preventing ovarian hyperstimulation syndrome

Area of Science:

• Reproductive Endocrinology and Infertility
• Pharmacology of Assisted Reproduction Technologies

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a significant risk in assisted reproduction technology (ART), characterized by ovarian enlargement and fluid shifts.
• Moderate to severe OHSS affects 3-8% of in vitro fertilization (IVF) cycles, posing serious health risks.
• Dopamine agonists, like cabergoline, were introduced to prevent OHSS in high-risk individuals.

Purpose of the Study:

• To evaluate the efficacy and safety of dopamine agonists in preventing OHSS among women at high risk during ART.
• To assess the impact of dopamine agonists on key reproductive outcomes, including live birth rates.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) up to August 2016.
• Included RCTs compared dopamine agonists (cabergoline, quinagolide, bromocriptine) against placebo, no intervention, or other treatments.
• Primary outcomes: incidence of moderate/severe OHSS and live birth rate; secondary outcomes: pregnancy and adverse event rates.

Main Results:

• Dopamine agonists significantly reduced moderate to severe OHSS incidence compared to placebo (OR 0.27, 95% CI 0.19-0.39), with moderate quality evidence.
• No significant difference was observed in live birth, clinical pregnancy, multiple pregnancy, or miscarriage rates.
• Adverse events, particularly gastrointestinal issues, were more frequent with dopamine agonists (OR 4.54, 95% CI 1.49-13.84), especially with quinagolide.

Conclusions:

• Dopamine agonists are effective in preventing moderate to severe OHSS in high-risk ART patients, though they may increase adverse events.
• Pregnancy outcomes (live birth, clinical pregnancy, miscarriage) are not significantly affected by dopamine agonist use.
• Further research is needed on optimal dosing, comparisons with other interventions, and combination therapies.