Effect of cabergoline on vascular permeability markers with the risk of ovarian hyperstimulation syndrome

The ovarian hyperstimulation syndrome (OHSS) results from enhanced vascular permeability, from activated endothelial vascular growth factor (VEGF). The selective dopamine receptor type 2 agonist cabergoline inactivates VEGF receptor 2 (VEGFR2), by blocking the further functions of VEGF, and prevents higher vascular permeability. Objective. To evaluate the effect of cabergoline on vascular permeability markers (VEGF, VEGF receptor 1 (VEGFR1), and VEGFR2 in the serum of women at risk for OHSS. Subject and methods. One hundred and sixty-eight women included in the IVF program were examined. Group 1 included 65 women at risk for OHSS who were given, for the prevention of this condition, oral cabergoline in a daily dose of 0.5 mg on the following day after transvaginal puncture for 5 days before the embryo transfer (ET) day. Group 2 consisted of 63 similar patients who did not take the drug. According to the development of OHSS, the patients were divided into subgroups: 1a (n = 38) and 2a (n = 30) without the syndrome being developed; 1b (n = 7) and 2b (n = 15) with OHSS. Group 3 comprised 40 women who had no risk factors OHSS (a control group). ELISA was used to measure the serum levels of VEGF, VEGFR1, and VEGFR2 in 90 high-risk patients and 40 control women. Results. On day 5 after cabergoline intake, Subgroup 1a women were found to have higher levels of soluble forms of VEGFR1 (p < 0.0007) and VEGFR2 (p < 0.0049) than the patients who did not take the drug. By the ET day, the OHSS subgroups versus the non-OHSS ones demonstrated a manifestation of the syndrome with lower VEGF1 and VEGF2 levels (p < 0.05). The administration of cabergoline could reduce the absolute risk of OHSS by 19% (95% confidence interval, 5-33%). Conclusion. The preventive effect of the selective dopamine receptor type 2 agonist cabergoline in the women at risk for OHSS shows itself as an increase in the serum levels of soluble VEGF1 and VEGF2 forms, which favors the optimal balance between these indicators and the maintenance of the physiological mechanism for vascular permeability.

ovarian hyperstimulation syndrome, selective dopamine receptor type 2 agonists, cabergoline, mechanism of vascular permeability, endothelial vascular growth factor, endothelial vascular growth factor receptor 1, endothelial vascular growth factor receptor 2