How to avoid ovarian hyperstimulation syndrome: a new indication for dopamine agonists.

Ovarian hyperstimulation syndrome (OHSS) is the most serious iatrogenic complication associated with ovarian stimulation. Despite the numerous breakthroughs that have been made in other areas of assisted reproduction technology, it is only in recent years that the understanding of OHSS has advanced sufficiently to develop treatment options aimed at reducing the incidence and effects of OHSS. However, suitable predictors and tests with which to identify susceptible patients remain unreliable, although anti-Müllerian hormone is currently a good risk-factor candidate. More progress has been made with the prevention of OHSS, and physicians now have a wide range of treatment options, including coasting, re-initiation of gonadotrophin-releasing hormone (GnRH) antagonist and induction of a luteinizing hormone flare-up using GnRH agonist. Recently, vascular endothelial growth factor (VEGF) has been identified as a key player in the vascular permeability that is associated with OHSS. The use of the dopamine agonist cabergoline has been found to reduce the effects of VEGF-mediated vascular permeability without compromising implantation and pregnancy rates. Together, these treatments will complement the ongoing progress with other procedures such as in-vitro maturation and oocyte vitrification, and enable physicians to improve the prediction and prevention of OHSS.