title: Pharmacologic Interventions in Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Network Meta-Analysis.
abstract: Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of controlled ovarian stimulation. Randomised controlled trials (RCTs) have proven several pharmacologic interventions to be effective in OHSS prevention, but these trials have seldom compared multiple drugs. We identified randomised controlled trials (RCTs) through June 2015 by searching databases and compared 11 intervention strategies in preventing OHSS (primary outcome) and their influence on pregnancy rate (secondary outcome). A network meta-analysis was used to evaluate the relative effectiveness among treatments and to create a rank probability table. Thirty-one RCTs were identified, including 7181 participants. Five pharmacologic interventions were superior to placebo in decreasing OHSS incidence: aspirin [relative risk (RR) 0.07, 95% credible interval (CrI) 0.01-0.30, p < 0.05], intravenous (IV) calcium [RR 0.11, 95% CrI 0.02-0.54, p < 0.05], cabergoline [RR 0.17, 95% CrI 0.06-0.43, p < 0.05], metformin [RR 0.20, 95% CrI 0.07-0.59, p < 0.05] and IV hydroxyethyl starch (HES) [RR 0.26, 95% CrI 0.05-0.99, p < 0.05]. The rank probability demonstrated aspirin (Rank 1: 36%) and IV calcium (Rank 1: 35%) to be the most efficacious. Additionally, albumin might decrease the pregnancy rate when compared with placebo [RR 0.85, 95% CI 0.74-0.97, p < 0.05]. This conclusion provides a relative standard and objective reference for choosing an OHSS prophylactic agent.
authors.affiliation: Department of Obstetrics &Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, P.R. China.|Zhong-shan School of Medicine, Sun Yat-sen University, Guangzhou City, 510082, P.R. China.
authors.forename: Jun-Liang
authors.initials: JL
authors.lastname: Guo
authors.affiliation: Department of Obstetrics &Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, P.R. China.|Zhong-shan School of Medicine, Sun Yat-sen University, Guangzhou City, 510082, P.R. China.
authors.forename: Duo-Duo
authors.initials: DD
authors.lastname: Zhang
authors.affiliation: Zhong-shan School of Medicine, Sun Yat-sen University, Guangzhou City, 510082, P.R. China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics &Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, P.R. China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Zhong-shan School of Medicine, Sun Yat-sen University, Guangzhou City, 510082, P.R. China.
authors.forename: Xi-Meng
authors.initials: XM
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics &Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, P.R. China.
authors.forename: Can-Quan
authors.initials: CQ
authors.lastname: Zhou
authors.affiliation: Department of Obstetrics &Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, 510080, P.R. China.
authors.forename: Shu-Zhong
authors.initials: SZ
authors.lastname: Yao
mesh_terms: D005260:Female; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000188:drug therapy* / Q000517:prevention & control*; D011247:Pregnancy; D018873:Pregnancy Rate; D017594:Publication Bias; D016896:Treatment Outcome