Dados do Trabalho

Title

Use of high dose modified protocol, with GnRHant and Cabergoline in the treatment of Ovarian Hyperstimulation Syndrome

Objective

Analyze the Ovarian Hyperstimulation Syndrome (OHSS) data, in the clinic cases, when used, High Dose GnRH antagonist, plus Cabergoline and symptomatic (adjuvant) medications.

Methods

A retrospective observational study, with the evaluation of, Fértilis Assisted reproduction clinic data. Fifty-five patients with OHSS were treated with Cetrorelix in high dosage, plus Cabergoline and symptomatic medications (Albumin, Metamucil, Kyss Kryss, Tramadol, Aspirin, Simethicone, and Oral Hydration) on the day of oocyte pickup. In patients with more than 15 eggs collected, Estradiol more than 3000 pg/ml and low body composition. Because of the possibility of lethality in the cases, we did not have a control group, and we compared the results with published data.

Results

Of 55 patients with OHSS, submitted to the protocol, (78.0%) were classified as mild, (22.0%) as moderate, and we did not have severe cases. Of the mild cases (24.0%) did not have clinical symptoms, (55.0%) had a 4-day period with symptoms, (14.0%) had 7 days with symptoms, and (7.0%) had 10 days with symptoms. Sixteen patients (29.0%) were submitted to a Culdocentesis in the clinic, due to the ascites, and there were no hospitalizations. With respect to age, patients (55.0%) had less than 35 years, (36.0%) had between 35 and 39 years, and (9.0%) had more than 40 years. In (60.0%) of the cases, the patients were diagnosed with PCO, (20.0%) with Endometriosis, and (25.0%) with low testosterone levels. Some cases had more than one pathology.

Conclusion

The use of the protocol with Cabergoline, and GnRHant alone, or in conjunction, diminishes but does not avoid the presence of severe OHSS. The modified treatment with high-dose GnRHant, plus Cabergoline and adjuvant medications, after egg collection, showed efficiency in the control of OHSS. The action of the GnRHant diary plus Cabergoline is fast (24h), but the higher dose at once, seems to have a more drastic effect on the hormonal block. The modified treatment with Cetrorelix in high doses plus Cabergoline and adjuvants were made on an outpatient basis, avoiding hospitalizations, shortening the time, diminishing the level of the symptoms, avoiding severe cases and hospitalizations, and could be a safe alternative to conventional treatments.

Keywords

Ovarian Hyperstimulation Syndrome; In Vitro Fertilization; GnRHant; Cabergoline.