الفهرس 
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Abstract
SUMMARY
Ovarian hyperstimulation syndrome (OHSS), an iatrogenic and potentially life-threatening disease process, which may occur in healthy young women undergoing controlled ovarian hyperstimulation (COH). This syndrome has been the subject of maximum research and innovation since the inception of assisted reproductive technology (ART). As the exact etiopathogenesis of this syndrome is still elusive, the treatment is largely empirical and thus prevention forms the mainstay of management.
The preventive strategies aim, to target women at high risk of developing OHSS and institution of various pharmacological and non-pharmacological interventions on them.
The pharmacological tools being used are: low-dose follicle stimulating hormone (FSH) or gonadotropin-releasing hormone antagonist protocol during stimulation, albumin infusion at the time of oocyte recovery, dopamine agonist cabergoline (Cb2) started from the day of ovulation trigger and institution of an insulin sensitizer like metformin, whereas the non-pharmacologic modalities incorporated are: Coasting, cycle cancellation, cryopreservation of all embryos for future transfer or use of in vitro maturation.
In the present study, we aimed to evaluate the effectiveness of intravenous (IV) calcium gluconate infusion in comparison to the dopamine agonist cabergoline in preventing OHSS in high risk patients undergoing assisted reproductive technique cycles.
This study was carried out in the IVF centre in faculty of medicine Cairo University in the period from January 2018 till the end of December 2019.
It was a comparative study in which the 40 high risk patients after meeting the strict inclusion and the exclusion criteria were randomly divided into two groups with 20 subjects in group I and 20 in group II. The women with even registration numbers were in group I and were administered IV calcium gluconate infusion while the remaining 20 who had odd registration numbers belonged to group II and were receive the dopamine agonist Cb2.
In this study too, we incorporated these risk factors and targeted them to either of the preventive strategy.
It is noteworthy that in this study we compared the two drugs which ultimately targeted the same key molecule: VEGF. The pathway of reaching the target and the mode of administration of both the drugs might be different but the preventive mechanism was same, i.e., either antagonizing VEGF receptor as in Cb2 or decrease VEGF levels as with calcium gluconate infusion.
All these pathophysiologic mechanisms (decreased synthesis of renin, angiotensin II and VEGF) which occurs from calcium gluconate infusion, therefore prevents the development of OHSS in such high risk patients undergoing ART cycles. Our results also document that calcium infusion can effectively prevent the development of severe OHSS and decreases OHSS occurrence rates without any major adverse affect when used for high-risk patients such as those with PCOS. It also needs to be reiterated that very few studies have been carried out on the efficacy of this new strategy of calcium gluconate infusion and comparison between this novel protocol and the established role of dopamine agonist is the first of its kind.
We can say that even though both the drugs were found to be equally effective for the prevention of OHSS and most importantly in decreasing the severity of this potentially life-threatening complication, their effect on the implantation process and the comparison of the pregnancy rate, implantation rate and miscarriage rate was not computed which accounts for the limitation of this study. Larger well designed trials need to be carried out incorporating the aforementioned factors as well as measurements of VEGF levels in both the study groups. Nevertheless, as both the drugs are safe, cheap and have comparable success rates either of them can be employed as a treatment strategy for patients with high risk factors for OHSS undergoing ART cycles.