PROPHYLACTIC CABERGOLINE VERSUS COASTING PROCEDURE TO CONTROL SEVERITY OF OVARIAN HYPERSTIMULATION SYNDROME IN PCOS WOMEN ASSIGNED FOR ICSI
Youssef M Abdel Zaher
Obstetrics & Gynecology Department, Faculty of Medicine, Benha University
Objectives: To evaluate outcome of polycystic ovary syndrome (PCOS) women underwent ICSI cycles under cabergoline (Cab) therapy for control of ovarian hyperstimulation syndrome (OHSS) development in comparison to Coasting (Coast) strategy. Patients & Methods: Women who developed serum estradiol (E2) of >4000 pg/ml and/or sonographic detection of >20 follicles each ≥10 mm in diameter and at least 20% ≥15 mm diameter were divided into two equal groups: Group Cab received cabergoline 0.5 mg daily for 8 days and Group Coast underwent coasting strategy. Evaluated parameters included the frequency and severity of OHSS, clinical pregnancy rate (CPR). Results: On day of hCG injection, mean ovarian diameter and serum E2 levels were significantly lower in both Coast and Cab groups compared to at categorization measures with significant difference in favor of Cab. No patient developed OHSS of more than grade IV, 49 women had OHSS of grades I-II and 15 women of grade III and IV with non-significant difference between both groups. Clinical scorings of OHSS manifestations were significantly lower with Cab versus Coasting. Fifteen patients developed US detected ascites and 4 patients had clinically detected ascites with significantly lower frequency in Cab group. Three patients required hospitalization; 2 patients for severe distension and one for severe nausea and vomiting. Oocyte count, total embryo count and total good embryo count, and fertilization and clinical pregnancy rates were significantly favorable with Cab. Conclusion: Both coasting procedure and prophylactic Cab effectively reduced the incidence and severity of OHSS. Prophylactic Cab provided superior results to Coasting manifested as significant reduction of OHSS severity manifestations with significant improvement of clinical pregnancy rate.