Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis

BACKGROUND: Recently, dopamine agonists were proposed as a prophylactic treatment for ovarian hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. METHODS: We conducted a systematic review and meta-analysis of randomized trials comparing the prophylactic effect of the dopamine agonist, cabergoline, versus no treatment in IVF/ICSI cycles. Primary outcome was OHSS incidence per randomized woman. Secondary outcomes were live birth rate, ongoing pregnancy rate, clinical pregnancy rate and miscarriage rate. Searches (until September 2009) were conducted in MEDLINE, EMBASE, Science Direct, Cochrane Library and databases of abstracts. RESULTS: Four randomized trials entailing 570 women were included. There was evidence of a statistically significant reduction in the incidence of OHSS in the cabergoline group (OR 0.41, 95% CI 0.25-0.66) with an absolute risk reduction of 12% (95% CI 6.1-18.2%), but there was no statistically significant evidence of a reduction in severe OHSS (OR 0.50, 95% CI 0.20-1.26). There was no evidence for a difference in clinical pregnancy rate (OR 1.07, 95% CI 0.70-1.62) and miscarriage rate (OR 0.31, 95% CI 0.03-3.07). CONCLUSION: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence, but not the severity of OHSS, without compromising pregnancy outcomes.