The vascular endothelial growth factor (VEGF) is a crucial element for increased vascular permeability which determines ovarian hyperstimulation syndrome (OHSS). Dopamine receptor agonists can selectively inhibit VEGF-induced vascular permeability without interfering with angiogenesis. Vascular endothelial growth factor receptor-2 (VEGFR-2) phosphorylation reduction seems to he associated with this effect. The preventive use of dopamine receptor agonists reduces the risk of OHSS in women after ovarian stimulation for in vitro fertilization (IVF). Statistically, evidence of their preventive effect on the severe OHSS is not as clear as on the moderate OHSS. The use of dopamine receptor agonists does not influence the outcome of IVF cycles. The occurrence of obstetric or neonatal complications is similar with that in control groups. The oral administration of cahergoline is the best studied dopamine receptor agonists regimen in the prevention of OHSS. High-dose quinagolide is rarely applied due to its intolerable side effects. Oral bromocriptine can also be occasionally associated with severe gastric discomfort, although less frequently than with quinagoline. Rectal bromocriptine is used with more and more frequency because of its safety, but it still requires further study. Although published data suggest that dopamine agonists also improve the clinical evolution of established OHSS, no randomized controlled trials have been reported to confirm their effectiveness. The use of dopamine receptor agonists may be combined with with other strategies to prevent or control OHSS, such as GnRH antagonists, in order to improve its efficacy.
展开▼
