Dopamine agonists for preventing ovarian hyperstimulation syndrome.

Area of Science:

• Reproductive Medicine
• Endocrinology
• Clinical Trials

Background:

• Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproduction technology (ART), affecting 3-8% of in vitro fertilisation (IVF) cycles.
• OHSS involves enlarged ovaries and fluid shifts, leading to bloating and potential thromboembolism.
• Dopamine agonists are used for secondary prevention of OHSS in high-risk individuals undergoing ART.

Purpose of the Study:

• To evaluate the effectiveness and safety of dopamine agonists in preventing OHSS in women at high risk during ART.
• To assess the impact of dopamine agonists on OHSS incidence and various pregnancy outcomes.

Main Methods:

• Conducted a systematic review of randomised controlled trials (RCTs) up to May 2020, searching multiple databases.
• Included 22 RCTs with 3171 women at high risk of OHSS, comparing dopamine agonists (cabergoline, quinagolide, bromocriptine) against placebo/no intervention, co-interventions, or other active treatments.
• Primary outcomes were moderate/severe OHSS incidence and live birth rate; secondary outcomes included clinical pregnancy, multiple pregnancy, miscarriage, and adverse events.

Main Results:

• Dopamine agonists probably reduced moderate/severe OHSS risk compared to placebo/no intervention (OR 0.32, 95% CI 0.23-0.44).
• Uncertainty exists regarding the effect of dopamine agonists on live birth rates, clinical pregnancy, multiple pregnancy, miscarriage, and adverse events.
• When used with co-interventions, dopamine agonists may decrease OHSS risk, but their impact on pregnancy outcomes is uncertain.

Conclusions:

• Dopamine agonists likely decrease moderate or severe OHSS incidence when compared to placebo or no intervention.
• Evidence is insufficient to determine the effect of dopamine agonists on adverse events and key pregnancy outcomes.
• The comparative effectiveness of dopamine agonists against other active interventions for OHSS prevention remains unclear.