Comparison of the effect of letrozole versus cabergoline for prevention of ovarian hyperstimulation syndrome (OHSS) in patients under ovulation induction treatments and IVF cycles

Document Type : Original Article

Authors

1 Professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate professor, Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant professor, Department of Emergency Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Resident of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: The effectiveness of letrozole and cabergoline for treatment of ovarian hyperstimulation syndrome (OHSS) has been evaluated and proved separately in previous studies, but there is no study to compare the effectiveness of these two drugs, therefore, this study was performed with aim to compare the effect of letrozole versus cabergoline for prevention of ovarian hyperstimulation syndrome (OHSS) in patients under ovulation induction treatments and IVF cycles.
Methods: This randomized, double-blind clinical trial was performed on 60 patients with complain of infertility who referred to Milad infertility center in Mashhad from April 2014 to July 2015 and were treated with ovulation induction drugs and developed the first sign and symptoms of ovarian hyperstimulation syndrome (OHSS). By randomized block method, the patients were divided into cabergoline and letrozole groups. Then, the researcher administered 5 mg letrozole to the patients of letrozole group after pick up for two weeks. Similarly, the researcher administered 0.5 mg cabergoline to the patients of cabergoline group from the day of pick up for 8 days. Then, the patients were weekly evaluated for 4 weeks in terms of any development in signs and symptoms of OHSS. Data was analyzed by SPSS software (version 11.5) and Chi-square, independent-t, and reapeted measures tests. PResults: There was no significant difference between two groups in terms of type of infertility (primary or secondary) (P=0.562), history of polycystic ovarian syndrome (P=0.584) and history of ovarian hyperstimulation syndrome (P=1.000). Among 60 patients, 25 (42%) had no need to hospitalization and were treated as outpatient, but 35 (58%) were hospitalized for 1 to 8 days during the study. There was no significant difference between two groups in terms of duration of hospitalization (P=1.000), Additionally in terms of clinical improvement during weekly follow-up (P=1.000).
Conclusion: Letrozole has similar effect as cabergoline for prevention of ovarian hyperstimulation syndrome (OHSS).

Keywords

References

  1. Kazem M, Ali A. An overview of the epidemiology of primary infertility in Iran. J Reprod Infertil 2009; 10(3):213-6.
  2. Zeynalzadeh M, Basirat Z. Comparison of pregnancy and hyperstimulation syndrome rate with GnRH agonist and HCG in ovation induction of PCOS. Iran J Obstet Gynecol Infertil 2008; 11(2):101-6. (Persian).
  3. Novak E. Bereck & Novak's gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
  4. Fritz MA, Speroff L. Clinical gyneocologic endocrinologiy and infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
  5. Kaiser UB. The pathogenesis of the ovarian hyperstimulation syndrome. N Engl J Med 2003; 349(8):729-32.
  6. O'Brien K, Lazar E, Athanassiou A, Ravnikar V. Ovarian hyperstimulation syndrome associated with fetal trisomy 21. J Perinatol 2009; 29(5):388-90.
  7. Papanikolaou EG, Tournaye H, Verpoest W, Camus M, Vernaeve V, Van Steirteghem A, et al. Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile. Hum Reprod 2005; 20(3):636-41.
  8. Firouzabadi RD, Aflatoonian A, Davar R, Sekhavat L, Moghadam FM. Comparison of Low-Dose HCG plus GnRH Agonist with standard dose of HCG alone in intrauterine insemination cycles with antagonist protocols. Iran J Obstet Gynecol Infertil 2013; 16(46):1-6.
  9. Ferrero H, Garcia-Pascual CM, Pellicer N, Simon C, Pellicer A, Gomez R. Dopamine agonist inhibits vascular endothelial growth factor protein production and secretion in granulosa cells. Reprod Biol Endocrinol 2015; 13:104.
  10. Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev 2012; 2:CD008605.
  11. Hosseini MA, Aleyasin A, Mahdavi A, Nezami R, Safdarian L, Fallahi P. The effectiveness of cabergoline for the prevention of ovarian hyperstimulation syndrome. Iran J Med Sci 2011; 36(3):207-12.
  12. Leitao VM, Moroni RM, Seko LM, Nastri CO, Martins WP. Cabergoline for the prevention of ovarian hyperstimulation syndrome: systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2014; 101(3):664-75.
  13. Carizza C, Abdelmassih V, Abdelmassih S, Ravizzini P, Salgueiro L, Salgueiro PT, et al. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reprod Biomed Online 2008; 17(6):751-5.
  14. Gomez R, Gonzalez-Izquierdo M, Zimmermann RC, Novella-Maestre E, Alonso-Muriel I, Sanchez-Criado J, et al. 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(11):5400-11.
  15. Kilic N, Ozdemir O, Basar HC, Demircan F, Ekmez F, Yucel O. Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles: a randomized controlled study. Avicenna J Med 2015; 5(4):123-7.
  16. Amir H, Yaniv D, Hasson J, Amit A, Gordon D, Azem F. Cabergoline for reducing ovarian hyperstimulation syndrome in assisted reproductive technology treatment cycles. A prospective randomized controlled trial. J Reprod Med 2015; 60(1-2):48-54.
  17. Garcia-Velasco JA, Quea G, Piro M, Mayoral M, Ruiz M, Toribio M, et al. Letrozole administration during the luteal phase after ovarian stimulation impacts corpus luteum function: a randomized, placebo-controlled trial. Fertil Steril 2009; 92(1):222-5.
  18. Akman L, Akdogan A, Erbas O, Aktug H, Sahin G, Tavmergen E. Effect of letrozole for prevention of ovarian hyperstimulation syndrome (OHSS) in a rat model. Fertil Steril 2013; 100(3):S258.
  19. Sweetman SC. Martindale: the complete drug reference. Chicago: Pharmaceutical Press; 2005.
  20. Fatemi HM, Kyrou D, Papanikolaou EG. Letrozole and cabergoline co-administration in the early luteal phase for prevention of OHSS in a high risk patient undergoing ovarian stimulation for IVF. J Fertilizat 2012; 2(4):111.
  21. Alvarez C, Alonso-Muriel I, Garcia G, Crespo J, Bellver J, Simon C, et al. Implantation is apparently unaffected by the dopamine agonist Cabergoline when administered to prevent ovarian hyperstimulation syndrome in women undergoing assisted reproduction treatment: a pilot study. Hum Reprod 2007; 22(12):3210-4.
  22. Gill SK, Moretti M, Koren G. Is the use of letrozole to induce ovulation teratogenic? Can Fam Physician 2008; 54(3):353-4.
  23. Elizur SE, Tulandi T. Drugs in infertility and fetal safety. Fertil Steril 2008; 89(6):1595-602.

The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 18, Issue 184
February 2016
Pages 1-8

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