Laparoscopic ovarian drilling versus GnRH antagonist combined with cabergoline as a prophylaxis against the re-development of ovarian hyperstimulation syndrome

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 0.25mg) was added when a leading follicle reaches 14-16mm combined with oral Cb in a dose 0.5mg a day before hCG, and for 8d for another 130 (n=130) women, and considered as group B. Pregnancy was diagnosed with BhCG level 25IU/L,14d after embryo transfer, followed with transvaginal ultrasound scanning (TVS) 2 weeks later to confirm intra-uterine pregnancy (IUP). Women were followed up weekly for 3months 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.