Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome

Abstract

Objective: The aim of this work was to investigate the value of laparoscopic ovarian drilling (LOD) compared with GnRH antagonist flexible protocol combined with cabergoline (Cb), as a prophylaxis against the re-development of ovarian hyperstimulation syndrome (OHSS) in women with clomiphene citrate-resistant polycystic ovary disease (CCR-PCOD) who had severe OHSS before in a previous ICSI cycle.

Study design: It is a prospective controlled study, where 250 CCR-PCOD women (n = 250) with a history of severe OHSS before, had been recruited for the study. LOD had been performed for 120 (n = 120) of the recruited women before ovarian induction, and considered as group A. GnRH antagonist (Cetrotide 0.25 mg) was added when a leading follicle reaches 14–16 mm combined with oral Cb in a dose 0.5 mg a day before hCG, and for 8 d for another 130 (n = 130) women, and considered as group B. Pregnancy was diagnosed with BhCG level ≥25 IU/L, ± 14 d after embryo transfer, followed with transvaginal ultrasound scanning (TVS) 2 weeks later to confirm intra-uterine pregnancy (IUP). Women were followed up weekly for 3 months for the possible development of any signs and symptoms of OHSS.

Results: None of the participants in group A developed severe OHSS, and only six women (5%) developed mild to moderate OHSS. The incidence of severe OHSS was significantly higher (n = 3, 15%) in group B compared with group A (p < .001). Another (n = 17, 13.3%) women in group B developed mild to moderate OHSS. The probability of developing severe OHSS was also significantly higher in group B as well (p = .031). Pregnancy rate (PR) was significantly higher in group A more than group B (67% versus 39%, respectively), and all were single intrauterine pregnancies (IUP) and all developed after fresh embryo transfer (ET), compared with frozen embryo transfer (FET) which was performed in 42 cases in group B after postponing ET due to significantly severe OHSS developed.

Conclusion: LOD could be considered a good prophylactic measure against OHSS, in addition to improving the total outcome of IVF cycles in women with CCR-PCOS.

Chinese abstract

目的:这项工作的目的是调查腹腔镜卵巢打孔（LOD）与GnRH拮抗剂灵活剂量联合卡麦角林（Cb）相比较的价值, 作为预防克罗米芬抗枸橼酸耐受性多囊卵巢综合征（CCR-PCOD）的女性卵巢过度刺激综合征（OHSS）再发展, 这些女性在之前的ICSI周期中曾有过严重的卵巢过度刺激综合征(OHSS)。

实验设计: 这是一个前瞻性的对照研究, 250名有严重OHSS病史的CCR-PCOD女性加入到这个研究。A组为120名女性(n = 120)在卵巢诱导前行LOC。使用hCG前一天在主导卵泡长到14-16mm时加入GnRH受体拮抗剂(0.25mg西曲肽)和0.5mg口服的卡麦角林。B组130例(n = 130)为第8天使用同样的方法。胚胎移植后的14天左右, 血βhCG ≥25IU/L可以诊断妊娠,2周后行经阴道超声检查确认宫内妊娠。这些女性每周随访一次直到3个月, 观察OHSS可能进展的症状和体征。

结果:A组无一例发生重度OHSS,仅有6例(5%)发生轻度到中度OHSS。B组发生重度OHSS(n = 3,15%)明显高于A组(p＜0.001)。B组的一部分女性(n = 17, 13.3%)发展成为轻度到中度OHSS。B组发生严重OHSS的可能性显著增高(p=.031)。A组的妊娠率明显高于B组(67% versus 39%), 并且所有病例都是新鲜胚胎移植后的单一宫内妊娠, 而B组的42个病例由于发生严重OHSS 推迟胚胎移植的时间而进行了冷冻胚胎移植。

结论:LOD对CCR-PCOS的患者除了改善IVF周期总的成果, 是很好的预防 OHSS的措施。

Keywords:

• Ovarian drilling
• GnRH antagonist
• Cabergolin
• ovarian hyperstimulation syndrome

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Expression of Concern: Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome

Acknowledgements

The authors are grateful for all women included in the study, especially those who had kindly agreed to go for LOD. We should also appreciate for all colleagues in the university department who offered their precious time and effort to complete this work.

Compliance with the ethical standards

I. All authors sharing in this work could confirm that they have never received any fund for this work, and they do confirm that they have no conflicts of interest.

II. This article does not contain any studies with animals performed by any of the authors.

III. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclosure statement

1. The study had been approved form the local Minia University Ethical committee before the start of case recruitment.

2. A formal written consent had been taken form each women recruited for the work, for both sharing in the work, and for publishing the work as well.

3. The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

4. The authors declare that they have no competing interests”

5. There was no funding offered for the corresponding or co-others to complete this work.

6. The authors are grateful for all women, who agreed to share in this work. We should also appreciate the great efforts offered from all colleagues and nurses in the university department.

References