Efeitos da bromocriptina na prevenção da síndrome do hiperestímulo ovariano precoce em mulheres de alto risco submetidas a fertilização in vitro / Effects of bromocriptine in the prevention of early ovarian hyperstimulation syndrome in high risk women submitted to in vitro fertilization

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Objective: To evaluate the effect of bromocriptine for the prevention of either early moderate or severe ovarian hyperstimulation syndrome (OHSS) in high risk women submitted to in vitro fertilization. Patients and Methods: A double-blind, prospective, randomized study was carried out between February 2006 and November 2007 at the Human Reproduction Center, Department of Gynecology, Teaching Hospital of the School of Medicine, University of São Paulo, at the Huntington Center of Reproductive Medicine and at the Human Reproduction Center of Santa Joana Hospital and Maternity Home. Twenty-eight women between 20 and 39 years of age, considered high risk for the development of OHSS (presence of 20 follicles at transvaginal ultrasonography on the day prior to human chorionic gonadotrophin [hCG] administration; serum estradiol levels 3000 pg/ml prior to or on the day of hCG administration and/or a significant bilateral increase in ovarian diameter), were included. The participants were randomly allocated to one of two groups. Women in group A (n=17) took a 2.0 mg tablet of folic acid and women in group B (n=11) took a 2.5 mg tablet of bromocriptine. Both treatments were taken orally daily for 14 days beginning on the day of hCG administration. Patients were evaluated on the day of hCG administration (D1) and seven days later (D2) at which time the following tests were performed: abdominal ultrasonography to detect the presence of ascites; blood sampling for the assessment of hemoglobin, hematocrit, leukocytes, platelets, urea, creatinine, SGOT, SGPT and vascular endothelial growth factor (VEGF). In addition, a 24-hour urine sample was collected to determine creatinine clearance and urinary sodium concentration. Results: All patients concluded the study. Fourteen had ascites at D2, 10 in group A (58.8%) and 4 (36.4%) in group B (p=0.246). Of these 14 patients, 7 fulfilled the criteria for severe OHSS, 6 in group A and 1 in group B. An increase was identified in mean VEGF values in group A (134.93 pg/ml) at D2, while a reduction was found in group B (119.11 pg/ml) (p=0.462). Conclusions: Bromocriptine did neither prevent early moderate nor severe OHSS in high risk patients submitted to in vitro fertilization; however, a reduction occurred in the intraperitoneal fluid volume and in serum VEGF levels.

ASSUNTO(S)

fertilização in vitro síndrome de hiperestimulação ovariana vascular endothelial growth factor fertilization in vitro ovarian hyperstimulation syndrome fator de crescimento endotelial vascular bromocriptina bromocriptin

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