Calcium infusion for the prevention of ovarian hyperstimulation syndrome A double blind randomized controlled trial

Capsule:
Intravenous calcium infusion effectively reduced the incidence of ovarian hyperstimulation syndrome development without reduction in the pregnancy rate.

Authors:
Waleed El-Khayat, M.D., Mostafa Elsadek, M.D.

Volume 103, Issue 1, Pages 101-105

Abstract:

Objective:
To evaluate the role of calcium infusion as a preventive strategy of ovarian hyperstimulation syndrome (OHSS) in women at high risk in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment cycles.

Design:
Double-blinded randomized controlled trial.

Setting:
University hospital department of obstetrics and gynecology and private IVF center.

Patient(s):
Two hundred women at risk to develop OHSS undergoing IVF/ICSI treatment cycle.

Intervention(s):
The intervention group (group 1; n = 100) received intravenous infusion of 10 mL 10% calcium gluconate in 100 mL 0.9% saline solution on the day of ovum pick-up (OPU) and days 1, 2, and 3 after, and the placebo group (group 2; n = 100) received 100 mL 0.9% saline solution on the day of OPU and days 1, 2, and 3 after.

Main Outcome Measure(s):
Incidence of OHSS.

Result(s):
OHSS incidence was significantly higher in the placebo group (group 2) than in the calcium infusion group (group 1): 23 (23%) vs. 7 (7%); moderate OHSS was significantly higher in group 2 than in group 1: 8 (8%) vs. 1 (1%); and severe OHSS was significantly higher in group 2 than in group 1: 4 (4%) vs. 0.

Conclusion(s):
Intravenous calcium infusion effectively reduced the incidence of OHSS development without reduction in the pregnancy rate.

Clinical Trial Registration Number:
NCT01427335.

  • Micah Hill

    Such a nice study design! Like Jason asked, I was curious if this only prevented early OHSS (which would seem biologically plausible)? An IV infusion daily for 4 days is certainly going to be expensive and invasive and time consuming for patients. Do the authors have any comments on the costs of this intervention? Since it is such an invasive preventive method, any thoughts on just targeting this intervention to the very highest risk patients?

  • Jason M. Franasiak

    Nicely designed study. Was there any information regarding the time from hCG administration OHSS was diagnosed? Did the intervention seem to prevent early onset as well as late onset OHSS in those who became pregnant?

    • Waleed El-Khayat

      Thanks a lot Jason for your nice comment, we did not get any case of early nor late OHSS in the calcium infusion group, even in the pregnant cases

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