Objectives: To evaluate and compare the preventive efficacy and safety of bromocriptine tablets and
calcium infusion on the frequency and severity of ovarian hyper-stimulation syndrome (OHSS) in polycystic ovary
syndrome (PCOS) women assigned for intracytoplasmic sperm injection (ICSI). Patients & Methods: The current
retro-prospective included 30 PCOS women (Group A) completed their ICSI program according to the protocol
assigned for the prospective part of the study and developed OHSS and 60 patients randomly divided into 2 equal
groups: Group B received bromocriptine 2.5 mg/day started on day of ovum pickup for 16 days and Group C
included 30 patients received intravenous 10% calcium gluconate 10 ml in 200 ml saline on the day of ovum pickup
and on days 1, 2 and 3 after ovum pickup. Ovarian stimulation program using gonadotrophine releasing hormone
(GnRH)-agonist was started at the luteal phase and when at least two follicles had reached a diameter of ≥18 mm,
rFSH was stopped, and a single subcutaneous bolus of 10,000 IU hCG was administered 36 hrs before the planned
time of oocyte retrieval. The ICSI procedure was performed and a maximum of two embryos were transferred 3days
after egg retrieval. Luteal support in the form of intravaginal progesterone was given daily from the day of oocyte
retrieval for 16 days and was continued for up to12 weeks if pregnancy occurred. Outcome was defined as the
frequency and severity of OHSS. Results: Ten patients (16.7%) in prospective part developed OHSS; 7 had mild and
3 patients had moderate manifestations with non-significant difference between both study groups as regards the
frequency of OHSS and that of moderate OHSS. On contrary; 13 patients (43.3%) in the retrospective part developed
OHSS with significantly higher frequency compared to the prospective part, irrespective to preventive therapy.
Among those had OHSS in the retrospective part; 7 had mild and 5 had moderate manifestation and one patient
developed severe manifestations necessitated hospitalization; an event that dose not occur in the prospective part.
Concerning severity, there was significantly higher frequency of high severity grades among patients of the
retrospective versus the prospective part of the study. Conclusion: Prevention of OHSS in PCOS women committing
ART is feasible and safe provided proper patient selection was followed. The non-significant difference between
both modalities of OHSS prevention as regards clinical pregnancy rate and both the frequency and severity of OHSS
opened the way for patients' preference of the preventive modality and their general health status to be the selection
guide. |
