title: Combination of cabergoline and embryo cryopreservation after GnRH agonist triggering prevents OHSS in patients with extremely high estradiol levels--a retrospective study.
abstract: OBJECTIVE
  Embryo cryopreservation after triggering oocyte maturation with GnRH agonist (GnRHa) in GnRH antagonist protocols has been proposed to prevent ovarian hyperstimulation syndrome (OHSS). However, a small percentage of patients still developed severe OHSS. The purpose of the study was to investigate the efficacy of preventing OHSS in patients at very high risk when cabergoline was given in addition to elective cryopreservation after GnRHa triggering.
  
  
  METHODS
  This is a retrospective observational study. The patients were stimulated with GnRH antagonist protocol. When serum E2 concentration was >6,000 pg/ml and there were more than 20 follicles ≥11 mm on the day of final oocyte maturation, GnRHa was used to trigger oocyte maturation. Cabergoline was given to augment the effect of preventing OHSS. The embryos were electively cryopreserved by vitrification and thawed in subsequent cycles. The primary outcome measure was the incidence of severe OHSS. The secondary outcome measure was the clinical pregnancy rate in the first frozen-thawed embryo transfer cycle.
  
  
  RESULTS
  One hundred and ten patients underwent 110 stimulated cycles were included for analysis. No patients developed moderate/severe OHSS. Mean E2 concentration on the day of final oocyte maturation was 7,873 pg/ml, and an average of 22.7 oocytes was obtained from each patient. One hundred and ten thawing cycles were performed, resulting in 69 clinical pregnancies (62.7 %).
  
  
  CONCLUSIONS
  Combining cabergoline and embryo cryopreservation after GnRHa triggering in GnRH antagonist protocol could prevent OHSS in patients at very high risk.
authors.affiliation: Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih Lin District, Taipei, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Mei-Zen
authors.initials: MZ
authors.lastname: Huang
authors.forename: Jiann-Loung
authors.initials: JL
authors.lastname: Hwang
authors.forename: Heng-Ju
authors.initials: HJ
authors.lastname: Chen
authors.forename: Bih-Chwen
authors.initials: BC
authors.lastname: Hsieh
authors.forename: Lee-Wen
authors.initials: LW
authors.lastname: Huang
authors.forename: Chii-Ruey
authors.initials: CR
authors.lastname: Tzeng
authors.forename: Kok-Min
authors.initials: KM
authors.lastname: Seow
mesh_terms: D000328:Adult; D000077465:Cabergoline; D015925:Cryopreservation; D004624:Embryo Transfer; D004873:Ergolines / Q000008:administration & dosage*; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D010062:Ovulation Induction; D011247:Pregnancy; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods
chemical_list: D004873:Ergolines; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D000077465:Cabergoline