Session 41: Embryo Development & Implantation

introduction: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic, serious and potentially fatal complication of ovarian stimulation which affects 1-14% of all IVF/ICSI cycles.A potential new strategy to prevent OHSS and reduce the severity is the use of a dopamine agonist.It was observed that the administration of dopamine agonist in immature rats at low doses simultaneously with HCG prevented an increase in vascular permeability and did not affect angiogenesis due to the availability of dopamine type 2 receptors.A number of clinical trials have recently tested the clinical usefulness of dopamine agonist as a possible way to reduce the occurrence and severity of OHSS.The objective of our systematic review and meta-analysis was to determine whether dopamine agonist can indeed reduce the occurrence and severity of OHSS syndrome in high risk patients undergoing ovarian hyperstimulation in IVF/ICSI treatment cycles.material and methods: We conducted a systematic review and meta-analysis of randomized trials comparing the preventive effect of use of the dopamine agonist cabergoline versus no treatment in IVF/ICSI cycles.Primary outcome was OHSS incidence per randomised woman.Secondary outcomes were live birth rate, ongoing pregnancy rate, clinical pregnancy rate, and miscarriage rate.Searches (until Sep 2009) were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts.data collection and analysis: Two review authors independently scanned the abstracts, identified relevant papers, assessed inclusion and trial quality and extracted relevant data.Validity was assessed in terms of method of randomisation, allocation concealment and outcomes.Primary outcome measure was OHSS incidence per randomised woman.Secondary outcome measures were Live birth rate clinical pregnancy rate, early miscarriage rate.results: Four randomized trials entailing 570 women were included.There was evidence of statistically significant reduction in the incidence of OHSS in the dopamine agonist group (OR 0.41 95% CI 0.25, to 0.66) with an absolute risk reduction of 12 % (95% CI, 6.07% to 18.2 %).There was no evidence of a reduction in severe OHSS (OR: 0.50, 95% CI 0.20 to 1.26).There was no evidence for a difference in clinical pregnancy rate (OR: 1.07, 95% CI (0.70 to 1.62) and miscarriage rate (OR: 0.31, 95% CI (0.03 to 3.07).conclusion: We conclude that dopamine agonist as a preventive treatment leads to a significantly lower OHSS incidence in high risk patients without compromising pregnancy outcomes, Selected oral communication SeSSion