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Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome.
Gynecol Endocrinol. 2018 Jul; 34(7):616-622.GE

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.

Authors+Show Affiliations

a Department of Obstetrics and Gynecology , Minia University College of Medicine , Minia , Egypt.b Department of Microbiology and Immunology , Fayoum University College of Medicine , Fayoum , Egypt.

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

29334275

Citation

Seyam, Emaduldin, and Enas Hefzy. "Laparoscopic Ovarian Drilling Versus GnRH Antagonist Combined With Cabergoline as a Prophylaxis Against the Re-development of Ovarian Hyperstimulation Syndrome." Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, vol. 34, no. 7, 2018, pp. 616-622.
Seyam E, Hefzy E. Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome. Gynecol Endocrinol. 2018;34(7):616-622.
Seyam, E., & Hefzy, E. (2018). Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome. Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, 34(7), 616-622. https://doi.org/10.1080/09513590.2018.1425989
Seyam E, Hefzy E. Laparoscopic Ovarian Drilling Versus GnRH Antagonist Combined With Cabergoline as a Prophylaxis Against the Re-development of Ovarian Hyperstimulation Syndrome. Gynecol Endocrinol. 2018;34(7):616-622. PubMed PMID: 29334275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome. AU - Seyam,Emaduldin, AU - Hefzy,Enas, Y1 - 2018/01/15/ PY - 2018/1/16/pubmed PY - 2018/10/26/medline PY - 2018/1/16/entrez KW - Cabergolin KW - GnRH antagonist KW - Ovarian drilling KW - ovarian hyperstimulation syndrome SP - 616 EP - 622 JF - Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology JO - Gynecol. Endocrinol. VL - 34 IS - 7 N2 - 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. SN - 1473-0766 UR - https://www.unboundmedicine.com/medline/citation/29334275/Laparoscopic_ovarian_drilling_versus_GnRH_antagonist_combined_with_cabergoline_as_a_prophylaxis_against_the_re-development_of_ovarian_hyperstimulation_syndrome L2 - http://www.tandfonline.com/doi/full/10.1080/09513590.2018.1425989 DB - PRIME DP - Unbound Medicine ER -