Work

Cabergoline for reducing the incidence of Ovarian Hyperstimulation Syndrome (OHSS) in women undergoing IVF/ICSI: a systematic review and meta-analysis of randomized controlled trials

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Dopamine agonists are increasingly used to prevent ovarian hyperstimulation syndrome (OHSS), but the evidence remains fragmented. We synthesized comparative evidence on cabergoline for preventing moderate-to-severe OHSS in women undergoing IVF/ICSI, analysing randomized and non-randomized evidence as separate evidence streams. Methods PubMed/MEDLINE, Embase, and the Cochrane Library were searched from inception to 1 May 2026. Randomized controlled trials (RCTs) and prospective non-randomized comparative studies comparing cabergoline with placebo or no treatment were eligible. Two reviewers independently performed selection, data extraction, and risk-of-bias assessment (RoB 2, ROBINS-I). In accordance with Cochrane guidance, randomized and non-randomized studies were not combined: the pooled estimate from the RCTs constituted the primary analysis, and the non-randomized studies were pooled separately as supportive evidence. Moderate-to-severe OHSS was expressed as an odds ratio (OR) using a random-effects model; certainty was rated with GRADE for each evidence stream. Results Eight studies (969 women) were included: six RCTs (748 women) and two prospective non-randomized comparative studies (221 women). In the primary analysis restricted to the six RCTs, cabergoline was associated with a lower incidence of moderate-to-severe OHSS (OR 0.41, 95% CI 0.26–0.64; I² = 18%; 138 events). The two non-randomized studies, analysed separately, gave a consistent estimate (OR 0.21, 95% CI 0.07–0.66; I² = 0%). Assuming a baseline risk of 100 per 1,000 women, this corresponds to 57 fewer cases of moderate-to-severe OHSS per 1,000 women (95% CI 34 to 72 fewer). The estimate was robust in leave-one-out analysis (range OR 0.33–0.47) and after excluding the trial subject to an Expression of Concern (OR 0.42, 95% CI 0.25–0.73). No funnel-plot asymmetry was detected (Egger’s P = 0.90), but with six trials publication bias could not be reliably excluded. Clinical pregnancy, live birth, and adverse events were inconsistently reported and were not pooled. Certainty of evidence was Low for the randomized stream and Very low for the non-randomized stream. Conclusions Low-certainty evidence indicates that cabergoline may reduce the incidence of moderate-to-severe OHSS in women undergoing IVF/ICSI. The available data did not identify a clear adverse signal for clinical pregnancy, live birth, or maternal adverse events, but were insufficient to determine these effects reliably. Cabergoline should be positioned as an adjunctive measure alongside, not instead of, contemporary primary prevention strategies.

Source: Middle East Fertility Society Journal

DOI: 10.1186/s43043-026-00362-w