Clinical Efficacy Of Vaginal Use Of Bromocriptine Mesylate In Preventing Ovarian Hyperstimulation Syndrome

Objective:To observe the clinical efficacy of vaginal administration of bromocriptine mesylate in preventing ovarian hyperstimulation syndrome.Methods:Participants: From March 2016 to December 2017,received in vitro fertilization-embryo transfer(IVF-ET)/intracytoplasmic sperm injection(ICSI-ET)technology at the Assisted Reproduction Center of Sichuan Provincial People's Hospital.Of the 162 patients who met the inclusion criteria,OHSS high-risk patients.Interventions: All high-risk patients who were enrolled in the OHSS were randomly assigned to the bromocriptine mesylate group and the control group randomly.Bromocriptine mesylate group(group A,n=82): after oocyte retrieval,patients immediately were given bromocriptine mesylate vaginally by 2.5 mg bid *7 d as well as hydroxyethyl starch 130/0.4 sodium chloride solution(Wanweng)intravenously by500 ml qd *7d.Control group(group B,n=80): after oocyte retrieval,patients immediately were given only hydroxyethyl starch 130/0.4 sodium chloride solution intravenously by 500 ml qd *7d.All enrolled patients were referred to the hospital on the3 rd and 7th days after oocyte retrieval.Observed indicators: incidence and grade distribution of OHSS,Ovary size and depth of thoracic and ascites,biochemical indicators,blood related indicators,coagulation and fibrinolytic indicators.Results:1.Basic information of two groups of patients:there were no significant differences in the composition ratio of long-term and long-term gonadotropin-releasing hormone between the bromocriptine mesylate group and the control group(P=0.282);The composition ratio of ganavifen,Policon and Lishenbao in the ovulation-promoting drugs in the bromocriptine mesylate group and the control group were no statistical differences(P=0.715);Both groups of patients were given Le Baode at the late stage of ovulation promotion.Therefore,there was no statistical analysis on the composition ratio of Le Baode.There were no significant differences in age,menstrual cycle,bodymass index(BMI),infertility period,Basal antral follicle number(bAFC),basic estrogen(Estrogen,E2),luteinizing(Luteinizing Hormone,LH),Follicle stimulating hormone(FSH)levels,Gonadotropin(Gn)initiation,Gn days,total Gn,HCG day E2 levels,number of oocytes retrieved,size of oocyte retrieved on oocyte retrieval day,etc.between the bromocriptine mesylate group and the control group(P>0.05)?2.Comparison of two sets of OHSS related indicators:(1)as for the incidence and grade distribution of OHSS,there were no significant differences about mild and moderate OHSS(P>0.05),but the incidence of severe OHSS in group A was significantly lower than that in group B(P<0.05),no matter on the 3rd or 7th days after oocyte retrieval(P>0.05).On the 3rd day after oocyte retrieval,no severe OHSS cases occurred in both groups,and no statistical analysis was performed.On the 7th day after oocyte retrieval,no severe OHSS occurred in group A,and 1 case of severe OHSS occurred in group B.And there is no statistical significance(P>0.05).(2)as for the Ovary size and depth of hydrothorax and ascites,there were no significant differences about the ovarian size and Pleural depth(P>0.05)on the 3rd day after oocyte retrieval,but statistically significant difference about depth of ascites(P<0.05).On the 7th day after oocyte retrieval,there were no significant differences about the ovarian size?depth of hydrothorax and ascites,(P>0.05).(3)as for the Biochemical Indicators,there were no significant differences about serum potassium ion concentrations,sodium ion concentrations,alanine aminotransferase(ALT)concentrations,aspartate transaminase(AST)concentrations and albumin concentrations(P>0.05),no matter on the 3rd or 7th days after oocyte retrieval.(4)as for the blood related indicators,the number of white blood cells(WBC)in group A was significantly lower than that in group B(P<0.05)and there were no significant differences about the Hematocrit(HCT)and Platelets(PLT)(P>0.05),no matter on the 3rd or 7th days after oocyte retrieval.(5)as for coagulation and fibrinolytic indicators,The prothrombin time(PT)and activated partial thromboplastin time(APTT)in group A were significantly longer than those in group B.(P<0.05)and the D-dimer content in group A was significantly lower than that in group B(P<0.05)on the 3rd day after oocyte retrieval,but no significant differences about the fibrinogen(FIB)and Thrombin time(TT)(P>0.05).On the 7th day afteroocyte retrieval,there were no significant differences about the PT?APTT?FIB?TT and D-dimer(P>0.05).Conclusion:(1)Vaginal administration of bromocriptine mesylate can effectively prevent the occurrence of severe ovarian hyperstimulation syndrome.(2)Vaginal administration of bromocriptine mesylate can obviously reduced the ascites volume and improve the blood concentration and hypercoagulability of patients with ovarian hyperstimulation syndrome.(3)In view of the features of economy?convenience and safety,it distinctly avoided the side effects of oral administration.Vaginal administration of bromocriptine mesylate can play a proactive role for reducing OHSS.