Efficacy and Safety of Intravenous Calcium Infusion for Preventing Ovarian Hyperstimulation Syndrome: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGAi-hua , LIUXiao-yan , LIUQi ,  FENGXin

Department of Pharmacy, Beijing Obstetrics Gynecology Hospital Affiliated to Capital Medical University, Beijing 100006, China;

Corresponding author：

FENGXin, Email: fengxin1115@126.com

Keywords：

Intravenous calcium infusion; Calcium gluconate; Ovarian hyperstimulation syndrome; Controlled ovarian hyperstimulation; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20160142

Video：

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Objective To systematically review the efficacy and safety of intravenous calcium infusion for preventing ovarian hyperstimulation syndrome (OHSS). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), CNKI, Sinomed and WanFang Data were searched from inception to July 2015 to collect randomized controlled trials (RCTs) and non-RCTs about intravenous calcium infusion for OHSS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of six studies involving 1 061 women were included. The results of meta-analysis showed that intravenous calcium infusion could reduce the incidence of moderate OHSS (RR=0.27, 95% CI 0.11 to 0.65, P=0.003), but not the incidence of severe OHSS (RR=0.77, 95% CI 0.23 to 2.63, P=0.68). In addition, intravenous calcium infusion had a tendency to increase the pregnant rate (RR=1.19, 95% CI 0.94 to 1.50, P=0.15). The subgroup analysis showed that, compared with placebo/no treatment, intravenous calcium infusion reduced the incidence of moderate OHSS, but not the incidence of severe OHSS. There were no statistical differences between intravenous calcium infusion and other positive control (cabergoline and hydroxyethyl starch) in the incidence of OHSS and pregnant rate. No side effect was reported in the studies included. Conclusions Current evidence indicates that intravenous calcium infusion can reduce the incidence of OHSS without influence pregnant outcomes. Due to the quantity and quality limitations of included studies, more high quality case-control or cohort studies are needed to verify the above conclusions.

Citation： WANGAi-hua, LIUXiao-yan, LIUQi, FENGXin. Efficacy and Safety of Intravenous Calcium Infusion for Preventing Ovarian Hyperstimulation Syndrome: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 920-925. doi: 10.7507/1672-2531.20160142 Copy

1.	Nastri CO, Ferriani RA, Rocha IA, et al. Ovarian hyperstimulation syndrome:pathophysiology and prevention. J Assist Reprod Genet, 2010, 27(2-3):121-128.
2.	Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update, 2003, 9(1):77-96.
3.	McClure N, Healy DL, Rogers PA, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet, 1994, 344(8917):235-136.
4.	Morris RS, Wong IL, Kirkman E, et al. Inhibition of ovarianderived prorenin to angiotensin cascade in the treatment of ovarian hyperstimulation syndrome. Hum Reprod, 1995, 10(6):1355-1358.
5.	Delbaere A, Bergmann PJ, Gervy-Decoster C, et al. Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome. Hum Reprod, 1997, 12(2):236-240.
6.	Tamarat R, Silvestre JS, Durie M, et al. Angiotensin II angiogenic effect in vivo involves vascular endothelial growth factor-and inflammation related pathways. Lab Invest, 2002, 82(6):747-756.
7.	Ortiz-Capisano MC, Ortiz PA, Harding P, et al. Decreased intracellular calcium stimulates renin release via calcium-inhibitable adenylyl cyclase. Hypertension, 2007, 49(1):162-169.
8.	Gurgan T, Demirol A, Guven S, et al. Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome. Fertil Steril, 2011, 96(1):53-57.
9.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochrane-handbook.org.
10.	Dmitrieva NV, Yakovenko SA, Zorina IV, et al. Comparison of calcium gluconate and starch solution in treatment of ovarian hyperstimulation syndrome. Reprod Biomed Online, 2010, 20(suppl 3):S41.
11.	Naredi N, Karunakaran S. Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome. J Hum Reprod Sci, 2013, 6(4):248-252.
12.	崔娜, 许月明, 郝桂敏, 等.静脉钙剂在卵巢过度刺激综合征高危患者中的临床应用.实用妇产科杂志, 2014, 30(10):772-775.
13.	El-Khayat W, Elsadek M. Calcium infusion for the prevention of ovarian hyperstimulation syndrome:a double-blind randomized controlled trial. Fertil Steril, 2015, 103(1):101-105.
14.	范燕宏, 邹君兰, 乔杰, 等.葡萄糖酸钙与万汶对预防卵巢过度刺激综合征的随机对照研究.中国妇产科临床杂志, 2015, 16(3): 233-236.
15.	Boothroyd C, Karia S, Andreadis N, et al. Consensus statement on prevention and detection of ovarian hyperstimulation syndrome. Aust N Z J Obstet Gynaecol, 2015, 55(6):523-534.
16.	Beierwaltes WH. The role of calcium in the regulation of renin secretion. Am J Physiol Renal Physiol, 2010, 298(1):F1-11.

1. Nastri CO, Ferriani RA, Rocha IA, et al. Ovarian hyperstimulation syndrome:pathophysiology and prevention. J Assist Reprod Genet, 2010, 27(2-3):121-128.
2. Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update, 2003, 9(1):77-96.
3. McClure N, Healy DL, Rogers PA, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet, 1994, 344(8917):235-136.
4. Morris RS, Wong IL, Kirkman E, et al. Inhibition of ovarianderived prorenin to angiotensin cascade in the treatment of ovarian hyperstimulation syndrome. Hum Reprod, 1995, 10(6):1355-1358.
5. Delbaere A, Bergmann PJ, Gervy-Decoster C, et al. Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome. Hum Reprod, 1997, 12(2):236-240.
6. Tamarat R, Silvestre JS, Durie M, et al. Angiotensin II angiogenic effect in vivo involves vascular endothelial growth factor-and inflammation related pathways. Lab Invest, 2002, 82(6):747-756.
7. Ortiz-Capisano MC, Ortiz PA, Harding P, et al. Decreased intracellular calcium stimulates renin release via calcium-inhibitable adenylyl cyclase. Hypertension, 2007, 49(1):162-169.
8. Gurgan T, Demirol A, Guven S, et al. Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome. Fertil Steril, 2011, 96(1):53-57.
9. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochrane-handbook.org.
10. Dmitrieva NV, Yakovenko SA, Zorina IV, et al. Comparison of calcium gluconate and starch solution in treatment of ovarian hyperstimulation syndrome. Reprod Biomed Online, 2010, 20(suppl 3):S41.
11. Naredi N, Karunakaran S. Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome. J Hum Reprod Sci, 2013, 6(4):248-252.
12. 崔娜, 许月明, 郝桂敏, 等.静脉钙剂在卵巢过度刺激综合征高危患者中的临床应用.实用妇产科杂志, 2014, 30(10):772-775.
13. El-Khayat W, Elsadek M. Calcium infusion for the prevention of ovarian hyperstimulation syndrome:a double-blind randomized controlled trial. Fertil Steril, 2015, 103(1):101-105.
14. 范燕宏, 邹君兰, 乔杰, 等.葡萄糖酸钙与万汶对预防卵巢过度刺激综合征的随机对照研究.中国妇产科临床杂志, 2015, 16(3): 233-236.
15. Boothroyd C, Karia S, Andreadis N, et al. Consensus statement on prevention and detection of ovarian hyperstimulation syndrome. Aust N Z J Obstet Gynaecol, 2015, 55(6):523-534.
16. Beierwaltes WH. The role of calcium in the regulation of renin secretion. Am J Physiol Renal Physiol, 2010, 298(1):F1-11.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Intravenous Calcium Infusion for Preventing Ovarian Hyperstimulation Syndrome: A Meta-analysis

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