Comparative study between Calcium gluconate with Diosmin, Cabergoline, and 1 Cabergoline with Diosmin in prevention of ovarian hyperstimulation syndrome in 2 high-risk women undergoing Intracytoplasmic Sperm Injection (ICSI) procedures

Aya M. Abdallah¹Marwa Kamal^2*Sumaiah J. Alarfaj³Thanaa A. Elmasry⁴Amal K Hussien¹Hatem A Sarhan¹Mohammed H Mosbeh⁵Mona Ali Saber¹Eman Sadek¹

• ¹Minia University Faculty of Pharmacy, Minya, Egypt
• ²Fayoum University, Faiyum, Egypt
• ³Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
• ⁴Tanta University Faculty of Pharmacy, Tanta, Egypt
• ⁵Minia University Faculty of Medicine, Menia Governorate, Egypt

Background: Ovarian Hyper-stimulation Syndrome (OHSS) is the main iatrogenic problem 19 linked to ovarian stimulation with reproductive medications. Increased vascular permeability is 20 considered the cause of OHSS. It leads to excess fluid flowing from blood vessels into surrounding 21 tissue. Serious consequences include imbalances in electrolytes and impairment of the heart, liver, 22 and kidneys. 23 Objectives: This study aims to the comparison of the efficacy of calcium gluconate and diosmin 24 combination, cabergoline alone, and a combination of cabergoline and diosmin in preventing 25 OHSS in high-risk individuals undergoing intracytoplasmic sperm injection (ICSI) procedures. 26 Methods: A prospective, randomized, single-blind, interventional study was carried out on 180 27 high-risk females for OHSS. They were divided into three groups, each with 60 women: Group A 28 received IV infusion of calcium gluconate and diosmin. Group B received cabergoline alone. 29 Group C received cabergoline and diosmin. Patients were regularly evaluated using clinical 30 examinations and ultrasound to check for signs of OHSS. The main outcome was the frequency 31 of moderate to severe OHSS. Secondary outcomes were the rates of clinical pregnancy, 32 miscarriage, and live birth. 33 Results: The research demonstrated that there was no significant difference in the prevalence of 34 mild OHSS among the three groups (p-value =0.91for each). Nevertheless, the three groups 35 showed a notable difference in the occurrence of moderate OHSS (p = 0.044) respectively. Notably, 36 severe ovarian hyper-stimulation syndrome wasn't observed in Group C. However, 13.3% of 37 patients in Group B and 6.6% in Group A were affected with a highly significant difference (p = 38 0.007). The chemical & clinical pregnancy rates across the three groups did not demonstrate any 39 statistically significant differences, (p-value of 0.53), (p-value of 0.17) correspondingly). 40 Conclusion: Our study found that using cabergoline and diosmin together in high-risk females 41 undergoing ICSI procedures was significantly more successful in preventing OHSS compared to 42 using calcium gluconate and diosmin or cabergoline alone. This combination did not impact 43 miscarriage, pregnancy rate, or the likelihood of multiple pregnancy.