Comparative Study of Cabergoline and Hydroxychloroquine to Prevent Ovarian Hyperstimulation Syndrome (OHSS) in PCOS Patients: A Pilot Randomized Clinical Trial

Comparative Study of Cabergoline and Hydroxychloroquine to Prevent Ovarian Hyperstimulation Syndrome (OHSS) in PCOS Patients: A Pilot Randomized Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Study of Cabergoline and Hydroxychloroquine to Prevent Ovarian Hyperstimulation Syndrome (OHSS) in PCOS Patients: A Pilot Randomized Clinical Trial Elnaz Salari, Negar Ajabi Ardehjani, Ladan Kashani, Kasra Jafari, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5855263/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 May, 2025 Read the published version in Journal of Ovarian Research → Version 1 posted 6 You are reading this latest preprint version Abstract Background This study compared the effectiveness of cabergoline and hydroxychloroquine in preventing ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation. Materials and Methods This double-blind, parallel, and randomized clinical trial was performed from April to June 2024. Forty-two patients with PCOS who were candidates for assisted reproductive techniques were randomized into two groups. The first group received 0.5 mg of cabergoline, and the second group received 400 mg of hydroxychloroquine for 8 days. Then, ultrasounds were conducted on days 3 and 5 after oocyte retrieval to assess for OHSS. Results Three and five days after oocyte retrieval, laboratory findings, and clinical outcomes were similar between the cabergoline and hydroxychloroquine groups. Key laboratory parameters, including hemoglobin, hematocrit, sodium, potassium, blood urea nitrogen, and creatinine, did not show significant differences between the groups. On day three, OHSS incidence didn’t have a significant difference between the hydroxychloroquine and cabergoline groups, both for the mild (31.58% vs. 42.86%) and moderate (15.79% vs. 9.52%) groups. Mild cases were observed in one of the patients in both groups 5 days after pickup (p = 0.942). No patients in the cabergoline group required hospitalization or treatment, compared to one in the hydroxychloroquine group (p = 0.127). Conclusion The incidence of OHSS was similar between cabergoline and hydroxychloroquine, with no significant differences observed in laboratory parameters or clinical outcomes after oocyte retrieval. However, given the study's sample size, further research is needed before these findings can be generalized to a larger population. Clinical trial number: http://www.irct.ir ; Registration number: IRCT20240305061171N1; Registration date: 2024 June 29 Ovarian Hyperstimulation Syndrome (OHSS) Polycystic Ovary Syndrome (PCOS) Cabergoline Hydroxychloroquine Reproductive Techniques Assisted (ART) Figures Figure 1 Introduction Ovarian hyperstimulation syndrome (OHSS), a potentially life-threatening condition, is the most severe iatrogenic side effect of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. The incidence of moderate to severe OHSS is predicted to be between 1% and 5% in all IVF cycles ( 1 ). OHSS is characterized by ovarian hypertrophy and fluid shift from intravascular to extravascular compartments ( 2 , 3 ). OHSS has two common pathologies: (i) increased vascular permeability, and (ii) human chorionic gonadotropin (hCG) is the triggering element for this syndrome ( 4 ). Additionally, this condition is characterized by overproduction of pro-inflammatory and vasoactive cytokines ( 5 , 6 ). Pretreatment risk factors for OHSS include young age (< 30 years), low body mass index (BMI), polycystic ovary syndrome (PCOS) or high basal antral follicle count (AFC), a history of elevated response to gonadotrophins (e.g., prior hyper-response or OHSS), and high basal anti-Müllerian hormone (AMH) concentrations ( 7 ). During and after ovarian stimulation (OS), elevated or rapidly rising serum estradiol concentrations, a large number of small follicles (8–12 mm), the use of hCG instead of progesterone for luteal phase support after IVF, a large number of oocytes retrieved (> 20), and pregnancy following fresh embryo transfer are associated with an increased risk of OHSS ( 8 , 9 ). The clinical diagnosis of OHSS has been classified into mild, moderate, severe, and critical forms ( 10 ). Criteria for diagnosing moderate to severe OHSS include symptoms such as nausea (with or without vomiting), clinically or ultrasound-detected ascites, hydrothorax, reduced urine output (oliguria), a hematocrit level over 45%, low protein levels (hypoproteinemia), and ovarian size greater than 8 mm ( 11 ). As mentioned earlier, OHSS often results from an exaggerated ovarian response to hormonal stimulation, particularly in high-risk groups such as patients with PCOS. PCOS is the most common cause of anovulatory infertility and a primary reason for undergoing assisted reproductive technology (ART) ( 7 , 12 ). Patients with PCOS have larger follicles, longer follicular phases, and higher median follicular concentrations of LH, FSH, and testosterone than ovulatory women with normal ovaries ( 13 ). During ovarian stimulation, women with PCOS respond to gonadotropins with extensive follicular development and a rapid surge in circulating estradiol. Additionally, the high sensitivity of polycystic ovaries to controlled ovarian stimulation (COS) makes controlling COS in patients with PCOS particularly challenging ( 7 , 14 ). Thus, preventing OHSS is a primary goal in reproductive therapy for these patients, necessitating individualized ovarian stimulation protocols and continuous monitoring ( 15 ). Several approaches have been introduced to lower the risk of moderate to severe OHSS ( 16 ). These approaches may change the stimulation protocol. These include replacing follicle-stimulating hormone (FSH) with low-dose hCG, employing GnRH antagonists instead of GnRH agonists during IVF, using a GnRH agonist instead of hCG to trigger final follicular maturation, and coasting and incorporating follitropin delta in GnRH-ant IVF cycles ( 17 , 18 ). Additionally, post-stimulation interventions, such as the administration of a GnRH antagonist after oocyte retrieval and cabergoline after the end of COS, were employed. Other strategies, such as cycle cancellation, freezing all embryos, and in vitro oocyte maturation, may also help reduce OHSS risk. However, aside from cycle cancelation, none of these interventions have been completely effective in preventing OHSS due to variations in efficacy and safety outcomes ( 16 ). Cabergoline, a D2 dopamine receptor agonist, effectively controls vascular permeability by inhibiting VEGFR2 phosphorylation. Several studies have explored its use in OHSS prevention, employing various doses and treatment regimens ( 19 ). This strategy is feasible for all women who are undergoing COS, with no evidence suggesting it impairs implantation ( 16 ). Hydroxychloroquine, an antimalarial drug, is also employed to address infertility on an immunologic basis and is widely prescribed for individuals with autoimmune diseases, mainly systemic lupus erythematosus (SLE) and other rheumatic conditions ( 20 ). Hydroxychloroquine exerts complex pleiotropic effects on multiple cell types. It reduces the production of pro-inflammatory cytokines, such as TNF-α, IFN-γ, IL-6, and IL-8, decreasing platelet aggregation. It also inhibits T follicular helper (Tfh) cells, suppresses toll-like receptor (TLR) activation, influences antigen-antibody interactions, and inhibits the release of endothelin-1 ( 21 – 23 ). Hydroxychloroquine also benefits vascular compliance and helps prevent endothelial dysfunction ( 24 , 25 ). Notably, several studies highlight the involvement of various cytokines in OHSS, suggesting interactions between systemic inflammatory cytokines such as IL-2, IL-6, IL-8, IL-10, IL-18, TNF-α, and VEGF and the pathophysiology of OHSS ( 17 , 26 – 29 ). Due to its immunomodulatory mechanism and ability to reduce systemic inflammation ( 23 , 30 , 31 ), hydroxychloroquine may also have potential utility in the prevention of OHSS; however, the precise mechanism in this space is still not completely clear. A key challenge for fertility specialists is preventing complications while striking a balance between effective ovarian stimulation for a successful outcome and minimizing the patient’s risk of OHSS. As a result, doctors must carefully estimate the initial gonadotropin dose to generate the maximum number of oocytes while minimizing the risk of OHSS ( 32 ). Based on this, we hypothesize that hydroxychloroquine, like cabergoline, may confer beneficial effects in women at high risk of OHSS, particularly those with PCOS. Materials and Methods Trial Design and Setting This study was a double-blind, parallel, and randomized clinical trial. It was conducted from April 03, 2024, to June 21, 2024, on women with PCOS who were candidates for ART at Arash Women’s Hospital, a tertiary hospital affiliated with Tehran University of Medical Sciences, Tehran, Iran. Ethical Considerations This study followed the principles outlined in the Declaration of Helsinki. The Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran, approved the study (Ethics Code: IR.TUMS.MEDICINE.REC.1402.699; 2024 March 04). Additionally, this study was registered on the Iranian clinical trial registry ( http://www.irct.ir ; Registration number: IRCT20240305061171N1; Registration date: 2024 June 29). All individuals provided informed consent. Eligibility Criteria Patients with PCOS who were undergoing ICSI and were aged 22–42 years, with BMI 20, and AMH levels > 3.36 ng/ml ( 33 ) were included in the study. Women diagnosed with PCOS according to the Rotterdam criteria ( 34 ), including at least two of the three following criteria: oligomenorrhea or amenorrhea, hyperandrogenism biochemical or clinical evidence, and ovarian morphology. Patients with the diagnosis of endometriosis, reduced ovarian reserve, chromosomal abnormalities, history of allergy to dopamine agonists or cabergoline, and failure to adhere to the prescribed medication regimen were excluded from the study. Recruitment and Baseline Assessment All the participants were recruited from patients referred to Arash Women’s Hospital. We recruited participants via conversations, and interested patients received detailed information about the study. After checking the eligibility criteria, the baseline assessment involved demographic characteristics (age, BMI, menstrual cycle regularity, and infertility type and factors) and hormonal profiles of patients (including serum levels of FSH, luteinizing hormone (LH), prolactin (PRL), progesterone, estradiol, testosterone, vitamin D, and anti-Müllerian hormone (AMH)), and ultrasounds were evaluated. Randomization, Concealment, and Blinding Participants were allocated randomly into one of the two arms at a ratio of 1:1 on the trigger day. The sequence was created by generating a block size of 4. The sequence of people in the randomized list was only available to an external observer responsible for participant allocation, and the researchers were not aware of it. A nurse selected and randomized the patients using a set of sequentially numbered, sealed opaque envelopes. The study was double-blinded since the physicians prescribed the interventions, physicians assessed the participantsfor the outcomes, and participants were blinded to the group allocation of the participants in the trial. Intervention The standard gonadotropin-releasing hormone antagonist (GnRH-ant) protocol was utilized for all patients. On the third day of the menstrual cycle, daily administration of 150 IU of rFSH ( Cinal-F, Cinnagen, Iran ) was initiated. During the protocol, ultrasonographic monitoring was performed, and the dose of rFSH was adjusted based on the progress of follicular development and patient response. After observing at least two 13 mm follicles, GnRH antagonist ( Cetrotide 0.25 mg, Serpero, Switzerland ) was administered via subcutaneous injection daily. When the dominant follicles reached a diameter of 18 mm, the final stage of oocyte maturation was induced with 0.2 mg of Decapeptyl ( Decapeptyl 0.2 mg, Ferring, Germany ) as a trigger. Oocyte retrieval was performed 36 hours later. On the trigger day, one group received 0.5 mg of cabergoline ( Caberlin, Iranhormone, Iran ), while the other group simultaneously administered 400 mg (2 × 200 mg tablets) of hydroxychloroquine ( Hydroxychloroquine sulfate, Rouzdarou, Iran ) for 8 days. In this study, the Freeze-all strategy was employed for all embryos. Clinical symptoms, laboratory tests, and ultrasounds were conducted on days 3 and 5 after the pickup procedure to assess for OHSS. Outcome Measurements On the third and fifth days following oocyte retrieval, OHSS was diagnosed, and its severity was determined using Golan's classification ( 35 ). Mild OHSS is defined as abdominal pain, nausea, and ovarian enlargement (8–12 cm) detected via ultrasound, with small amounts of fluid in the pelvis. Moderate OHSS is defined as more extensive ascites and nausea or vomiting requiring hospital admission. Severe OHSS is defined as significant fluid accumulation in the abdomen or thorax, shortness of breath, hematocrit > 55%, electrolyte imbalances, elevated blood urea nitrogen (BUN)/creatinine, reduced urine output, or kidney failure ( 35 ). At each visit, the patient's vital signs and weight were taken. A transvaginal ultrasound ( Philips Affiniti 70, Philips, Netherlands ) was performed to determine the ovarian volume and estimate the volume of pelvic free fluid. Data were obtained from the checklist, clinical and laboratory notes, and ultrasound reports. All patients were evaluated for cabergoline and hydroxychloroquine-related symptoms and side effects. Patients are also instructed to report any issues from day 8 until their next menstrual cycle. Sample size Since this was a pilot randomized clinical trial aimed primarily at assessing feasibility and generating preliminary data rather than testing a formal hypothesis, we determined the sample size based on the commonly used rule of thumb for pilot studies (typically 12 participants per arm) ( 36 ). Also, no prior studies have evaluated the effect of hydroxychloroquine on OHSS, so this pilot study was designed with a sample size of 21 patients per group. Statistical Analysis Data were analyzed using Stata version 17.0 and P-values < 0.05 were considered statistically significant differences. The normality of data distribution was evaluated using the Shapiro-Wilk test, skewness, kurtosis indices, as well as histograms and boxplots. To compare continuous variables, we used the Student's t-test (or its non-parametric alternative, the Mann-Whitney test), and for categorical variables, we used the Chi-square test (or Fisher's exact test). To evaluate the clinical effectiveness and safety of the intervention, we calculated the Number Needed to Treat (NNT) and Number Needed to Harm (NNH) along with their corresponding 95% confidence intervals (CIs). The NNT was derived as the reciprocal of the absolute risk reduction (ARR) between the intervention and control groups for incidence of any severity of OHSS: $$\:NNT=\:\frac{1}{{Risk}_{\text{c}\text{a}\text{b}\text{e}\text{r}\text{g}\text{o}\text{l}\text{i}\text{n}\text{e}\:\text{g}\text{r}\text{o}\text{u}\text{p}\:}-\:{Risk}_{\text{h}\text{y}\text{d}\text{r}\text{o}\text{x}\text{y}\text{c}\text{h}\text{l}\text{o}\text{r}\text{o}\text{q}\text{u}\text{i}\text{n}\text{e}\:\text{g}\text{r}\text{o}\text{u}\text{p}\:}}$$ Similarly, for adverse outcomes, NNH was calculated as the reciprocal of the absolute risk increase (ARI) for incidence of any severity ofOHSS:​ \(\:NNH=\:\frac{1}{{Risk}_{\text{h}\text{y}\text{d}\text{r}\text{o}\text{x}\text{y}\text{c}\text{h}\text{l}\text{o}\text{r}\text{o}\text{q}\text{u}\text{i}\text{n}\text{e}\:\text{g}\text{r}\text{o}\text{u}\text{p}\:}-\:{Risk}_{\text{c}\text{a}\text{b}\text{e}\text{r}\text{g}\text{o}\text{l}\text{i}\text{n}\text{e}\:\text{g}\text{r}\text{o}\text{u}\text{p}\:}}\) Additionally, odds ratios (ORs) and their 95% CIs were calculated using logistic regression to estimate the association between treatment group and binary outcomes. Due to the small number of outcomes, variables were analyzed as binary (presence/absence). Results Initially, 44 participants were screened, and 2 (4.5%) were subsequently excluded. The remaining 42 (95.4%) participants were randomly assigned to either the 50% cabergoline group (n = 21) or the 50% hydroxychloroquine group (n = 21). During the study, two participants in the hydroxychloroquine group withdrew from the trial as they failed to attend the follow-up visits after the second visit on day five post-trigger (Fig. 1 ). Baseline Characteristics The baseline demographic, clinical, and laboratory characteristics of participants in the cabergoline (n=21) and hydroxychloroquine (n=19) groups were comparable (Table 1). The mean age was 32.09±4.10 years in the cabergoline group and 29.58±4.78 years in the hydroxychloroquine group (p=0.113). Mean BMI, menstrual cycle regularity, and infertility type and factors showed no significant differences between the groups. Baseline laboratory parameters, including FSH, LH, AMH, and others, were similar across groups. Only the right AFC was slightly higher in the hydroxychloroquine group (p-value = 0.037). Table 1. Baseline characteristics of the participants. Characteristic Total (N=40) Hydroxychloroquine (N=19) Cabergoline (N=21) p-value Demographic and Clinical Age (SD) 30.90 (5.00) 29.58 (4.78) 32.10 (5.00) 0.113 BMI (SD) 27.08 (5.09) 25.88 (4.68) 28.17 (5.30) 0.158 Regular menstrual cycle (%) No 15 (37.50%) 7 (36.84%) 8 (38.10%) 0.616 Yes 24 (60.00%) 12 (63.16%) 12 (57.14%) Oligomenorrhea 1 (2.50%) 0 (0.00%) 1 (4.76%) Primary infertility (%) No 11 (27.50%) 6 (31.58%) 5 (23.81%) 0.583 Yes 29 (72.50%) 13 (68.42%) 16 (76.19%) Secondary infertility (%) No 30 (75.00%) 13 (68.42%) 17 (80.95%) 0.361 Yes 10 (25.00%) 6 (31.58%) 4 (19.05%) Female factor infertility (%) No 4 (10.00%) 2 (10.53%) 2 (9.52%) 0.916 Yes 36 (90.00%) 17 (89.47%) 19 (90.48%) Laboratory FSH (SD) 5.21 (1.78) 5.33 (2.00) 5.11 (1.59) 0.695 LH (SD) 5.47 (2.43) 5.46 (2.68) 5.48 (2.24) 0.972 AMH (SD) 5.84 (3.69) 6.36 (4.35) 5.38 (3.00) 0.407 TSH (SD) 2.07 (0.92) 1.81 (0.89) 2.31 (0.91) 0.085 PRL (SD) 134.11 (143.00) 118.89 (117.41) 148.56 (165.49) 0.524 Progesterone (SD) 4.75 (6.12) 5.51 (7.28) 4.07 (4.91) 0.466 Estradiol (SD) 36.03 (36.22) 31.83 (34.84) 39.84 (37.87) 0.492 Vitamin D (SD) 27.50 (11.14) 29.89 (14.19) 25.34 (7.10) 0.201 Testosterone (SD) 17.86 (18.35) 14.95 (19.66) 20.48 (17.14) 0.348 Sonographic AFC right (SD) 12.83 (2.22) 13.69 (2.44) 12.15 (1.81) 0.037 AFC left (SD) 13.33 (2.14) 13.69 (2.70) 13.05 (1.57) 0.382 Trigger Day a-GNRH Progesterone (SD) 1.25 (0.62) 1.19 (0.49) 1.30 (0.72) 0.568 Estradiol (SD) 2100.60 (466.31) 2187.74 (441.45) 2021.76 (484.65) 0.266 Trigger Cycle rFSH cinal (%) 75 3 (7.50%) 2 (10.53%) 1 (4.76%) 0.299 150 10 (25.00%) 7 (36.84%) 3 (14.29%) 225 24 (60.00%) 9 (47.37%) 15 (71.43%) 300 3 (7.50%) 1 (5.26%) 2 (9.52%) Abbreviations: Body mass index (BMI), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Anti-müllerian hormone (AMH), Prolactin (PRL), Antral follicle count (AFC). Post-Intervention Laboratory Parameters and Outcomes Three days after oocyte retrieval, laboratory findings and outcomes were broadly similar between groups (Table 2). Key laboratory parameters, such as hemoglobin, hematocrit, sodium, potassium, BUN, and creatinine, did not significantly differ between the cabergoline and Hydroxychloroquine groups (p>0.05 for all). Reported side effects, including nausea, vomiting, abdominal distension, pain, and oliguria, were comparable. OHSS incidence did not significantly differ between groups, with mild and moderate cases evenly distributed. None of the patients in the cabergoline group required treatment for OHSS, compared to one (5.26%) patient of hydroxychloroquine patients, although this difference was not statistically significant (p=0.299). Table 2. Laboratory parameters, outcomes, and the side effects three days after pick up. Parameters Total (N=40) Hydroxychloroquine (N=19) Cabergoline (N=21) p-value Laboratory Hb (SD) 11.87 (1.10) 11.86 (1.27) 11.89 (0.96) 0.938 HCT (SD) 35.92 (2.90) 36.22 (3.35) 35.64 (2.47) 0.536 Na (SD) 140.43 (1.97) 140.74 (0.81) 140.14 (2.61) 0.348 K (SD) 4.08 (0.15) 4.07 (0.15) 4.09 (0.16) 0.726 BUN (SD) 10.33 (3.71) 9.36 (2.08) 11.20 (4.61) 0.118 Cr (SD) 0.85 (0.09) 0.85 (0.08) 0.85 (0.10) 0.993 ALT (SD) 21.05 (10.44) 18.63 (6.25) 23.24 (12.91) 0.166 AST (SD) 19.70 (7.92) 18.26 (6.32) 21.00 (9.08) 0.281 ALK (SD) 133.73 (28.15) 129.79 (29.08) 137.29 (27.50) 0.407 Outcomes and Side Effects Transvaginal sonography (%) No 15 (37.50%) 8 (42.11%) 7 (33.33%) 0.534 Mild 18 (45.00%) 9 (47.37%) 9 (42.86%) Moderate 7 (17.50%) 2 (10.53%) 5 (23.81%) Nausea (%) No 20 (50.00%) 10 (52.63%) 10 (47.62%) 0.524 Mild 16 (40.00%) 6 (31.58%) 10 (47.62%) Moderate 3 (7.50%) 2 (10.53%) 1 (4.76%) Severe 1 (2.50%) 1 (5.26%) 0 (0.00%) Vomiting (%) No 38 (95.00%) 18 (94.74%) 20 (95.24%) 0.366 Mild 1 (2.50%) 0 (0.00%) 1 (4.76%) Moderate 1 (2.50%) 1 (5.26%) 0 (0.00%) Abdominal distention (%) No 20 (50.00%) 10 (52.63%) 10 (47.62%) 0.682 Mild 17 (42.50%) 7 (36.84%) 10 (47.62%) Moderate 3 (7.50%) 2 (10.53%) 1 (4.76%) Abdominal pain (%) No 18 (45.00%) 8 (42.11%) 10 (47.62%) 0.826 Mild 17 (42.50%) 8 (42.11%) 9 (42.86%) Moderate 5 (12.50%) 3 (15.79%) 2 (9.52%) Oliguria (%) No 33 (82.50%) 16 (84.21%) 17 (80.95%) 0.344 Mild 5 (12.50%) 3 (15.79%) 2 (9.52%) Moderate 2 (5.00%) 0 (0.00%) 2 (9.52%) Dyspnea (%) No 38 (95.00%) 18 (94.74%) 20 (95.24%) 0.942 Mild 2 (5.00%) 1 (5.26%) 1 (4.76%) OHSS (%) No 20 (50.00%) 10 (52.63%) 10 (47.62%) 0.704 Mild 15 (37.50%) 6 (31.58%) 9 (42.86%) Moderate 5 (12.50%) 3 (15.79%) 2 (9.52%) Treatment for OHSS (%) No 39 (97.50%) 18 (94.74%) 21 (100.00%) 0.287 Yes 1 (2.50%) 1 (5.26%) 0 (0.00%) Hospitalization (%) No 38 (95.00%) 17 (89.47%) 21 (100.00%) 0.127 Yes 2 (5.00%) 2 (10.53%) 0 (0.00%) Treatment hospitalization (%) No 37 (92.50%) 17 (89.47%) 20 (95.24%) 0.489 Yes 3 (7.50%) 2 (10.53%) 1 (4.76%) Abbreviations: Hemoglobin (Hb), Hematocrit (HCT), Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Cr), Alanine transaminase (ALT), Aspartate Transferase (AST), Ovarian hyperstimulation syndrome (OHSS). Five days post-retrieval, laboratory parameters remained comparable (Table 3). Incidence of OHSS was low and similar between groups, with mild cases reported in one of patients in both groups (p=0.942). Side effects, including abdominal pain and distension, were reported at low rates and did not differ significantly. Other side effects were not observed in both of the groups. In conclusion, the incidence of OHSS and side effect profiles were similar between cabergoline and hydroxychloroquine, with no significant differences observed in laboratory parameters or clinical outcomes after oocyte retrieval. Table 3. Laboratory parameters, outcomes, and the side effects five days after pick up. Parameters Total (N=40) Hydroxychloroquine (N=19) Cabergoline (N=21) p-value Laboratory Hb (SD) 12.30 (1.08) 12.26 (1.46) 12.33 (0.62) 0.841 HCT (SD) 37.37 (2.91) 37.26 (3.80) 37.47 (1.86) 0.824 Na (SD) 140.00 (1.20) 140.11 (1.10) 139.90 (1.30) 0.604 K (SD) 4.02 (0.13) 4.04 (0.14) 4.00 (0.13) 0.389 BUN (SD) 11.15 (2.99) 10.42 (2.61) 11.81 (3.22) 0.145 Cr (SD) 0.89 (0.09) 0.88 (0.08) 0.90 (0.10) 0.579 ALT (SD) 31.38 (16.21) 30.37 (19.52) 32.29 (12.94) 0.714 AST (SD) 28.10 (16.03) 28.58 (21.19) 27.67 (9.83) 0.860 ALK (SD) 141.65 (31.52) 137.21 (27.94) 145.67 (34.62) 0.404 Outcomes and Side Effects Transvaginal sonography (%) No 36 (90.00%) 17 (89.47%) 19 (90.48%) 0.916 Mild 4 (10.00%) 2 (10.53%) 2 (9.52%) Nausea (%) No 38 (95.00%) 18 (94.74%) 20 (95.24%) 0.942 Mild 2 (5.00%) 1 (5.26%) 1 (4.76%) Abdominal distention (%) No 38 (95.00%) 18 (94.74%) 20 (95.24%) 0.942 Mild 2 (5.00%) 1 (5.26%) 1 (4.76%) Abdominal pain (%) No 37 (92.50%) 18 (94.74%) 19 (90.48%) 0.609 Mild 3 (7.50%) 1 (5.26%) 2 (9.52%) OHSS (%) No 38 (95.00%) 18 (94.74%) 20 (95.24%) 0.942 Mild 2 (5.00%) 1 (5.26%) 1 (4.76%) Abbreviations: Hemoglobin (Hb), Hematocrit (HCT), Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Cr), Alanine transaminase (ALT), Aspartate Transferase (AST), Ovarian hyperstimulation syndrome (OHSS). On Day 3, the NNT for hydroxychloroquine versus cabergoline was 20, indicating that 20 patients would need to be treated with hydroxychloroquine (rather than cabergoline) to prevent one additional case of OHSS. No significant harm (NNH) was observed at this time point. By Day 5, the effect of hydroxychloroquine diminished, with no detectable preventive benefit (NNT not applicable). However, the NNH was 200, suggesting that 200 patients would need to receive hydroxychloroquine (instead of cabergoline) to result in one additional case of OHSS, reflecting a minimal and clinically insignificant risk. Table 4 presents the comparison of OHSS and clinical symptoms between the cabergoline and hydroxychloroquine groups on days 3 and 5 post-oocyte retrieval. The ORs and corresponding p-values indicate no statistically significant differences between the two groups for any of the assessed variables, including transvaginal sonography findings, nausea, abdominal distention, abdominal pain, and OHSS (all p-values > 0.05). These results suggest that neither cabergoline nor hydroxychloroquine demonstrated a superior effect in reducing the risk of OHSS or associated symptoms during the early post-retrieval period. Table 4. Comparison of OHSS and clinical symptoms between cabergoline and hydroxychloroquine groups on days 3 and 5 after pick-up Variables Day 3 Day 5 OR P-value OR P-value Transvaginal Sonography 1.455 (0.402-5.260) 0.568 0.895 (0.113-7.064) 0.916 Nausea 1.222 (0.353-4.235) 0.752 0.900 (0.052-15.466) 0.942 Abdominal Distention 1.222 (0.353-4.235) 0.752 0.900 (0.052-15.466) 0.942 Abdominal Pain 0.800 (0.229-2.793) 0.726 1.895 (0.158-22.751) 0.614 OHSS 1.222 (0.353-4.235) 0.752 0.900 (0.052-15.466) 0.942 Abbreviations: Odds ratio (OR), Ovarian hyperstimulation syndrome (OHSS). Discussion This randomized clinical trial evaluated the comparative effectiveness of cabergoline and hydroxychloroquine in preventing OHSS in patients with PCOS. In this study, patients were administered 0.5 mg of oral cabergoline daily, while another group was prescribed 400 mg of hydroxychloroquine for 8 days, starting on the trigger day. The findings presented in this study showed no statistically significant difference between the two groups in reducing the risk of OHSS in patients with PCOS at risk for developing OHSS. Cabergoline, a dopamine agonist, has been extensively studied for its ability to counteract the effects of vascular endothelial growth factor (VEGF), a key mediator in the increased vascular permeability seen in OHSS ( 37 – 39 ). Several systematic reviews and meta-analyses have revealed that by reducing VEGF receptor-2 phosphorylation, dopaminergic agonists minimize excessive fluid buildup and successfully prevent moderate-severe OHSS ( 16 , 40 , 41 ). In two studies, cabergoline effectively reduced OHSS risk in high-risk women undergoing IVF/ICSI ( 42 ). Also, data suggest the use of cabergoline in the management of patients with PCOS to provide better clinical control of ovarian response and consequently a reduction of the risk of OHSS, with no decrease in pregnancy rate ( 43 ). Several clinical trials have suggested the effectiveness of cabergoline as a preventive therapy for OHSS compared to alternative interventions such as albumin ( 44 ), cetrorelix ( 45 ), and calcium gluconate ( 46 ). In line with our results, these studies suggest that cabergoline is an optimal strategy for reducing OHSS incidences in high-risk patients. Our analysis shows that hydroxychloroquine is comparable to cabergoline in reducing the incidence of OHSS. Therefore, hydroxychloroquine is as effective as cabergoline in lowering the risk of OHSS in patients with PCOS who are at risk for developing OHSS. Numerous qualities of hydroxychloroquine, including its well-established safety profile and positive outcomes in long-term use, make it a promising candidate for clinical trials ( 47 ). A better understanding of the mechanisms of hydroxychloroquine's action has thus promoted recent advances in its therapeutic landscape. It has immunomodulatory and anti-inflammatory actions, which include enhancing Treg proliferation, suppressing pro-inflammatory cytokines, lysosomal membrane stabilization, and inhibition of phospholipase ( 47 – 49 ). It is reasonable to hypothesize that hydroxychloroquine could mitigate the inflammatory aspects of OHSS. This study represents a novel exploration of hydroxychloroquine's potential role in this context. To our knowledge, this is the first study to investigate the potentiality of hydroxychloroquine treatment in managing OHSS in patients with PCOS. Research on the safety of hydroxychloroquine for treating malaria and rheumatic conditions, including SLE, indicates that it does not significantly increase the risk of common adverse pregnancy outcomes, such as miscarriage, preterm birth, or restricted fetal growth ( 50 – 53 ). Additionally, a clinical study confirmed that hydroxychloroquine is safe for use during pregnancy in women with autoimmune disorders ( 54 ). Some studies suggest that hydroxychloroquine has a potential role in improving reproductive outcomes in patients with autoimmune or inflammatory conditions ( 55 , 56 ). Two clinical trials investigated the ability of hydroxychloroquine to modulate the immune system by the balance of pro-inflammatory and anti-inflammatory immune responses in women with repeated implantation failure (RIF) ( 47 , 57 ). Another trial study highlighted the protective effect of hydroxychloroquine in recurrent pregnancy loss (RPL) ( 58 ). A systematic review and meta-analysis have demonstrated that hydroxychloroquine administration may positively influence embryo transfer outcomes, including improved live birth and fertilization rates ( 59 ). A study has shown hydroxychloroquine's efficacy in improving adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia ( 60 ). Recent reports indicate that hydroxychloroquine is efficacious in improving adverse pregnancy outcomes ( 60 , 61 ). In line with previous studies, our findings suggest that hydroxychloroquine may be a suitable candidate for preventing OHSS in patients with PCOS. Our findings showed that on Day 3 post-oocyte retrieval, hydroxychloroquine had a modest preventive effect compared to cabergoline, with an NNT of 20. This suggests that 20 patients would need to be treated with hydroxychloroquine instead of cabergoline to prevent one additional case of OHSS. Importantly, no harm was observed at this time point, as reflected by the absence of a calculable NNH. By Day 5, however, the preventive effect of hydroxychloroquine appeared to wane, with the NNT becoming non-applicable and the NNH rising to 200, indicating a very low risk of harm. These findings suggest that while hydroxychloroquine may offer some early benefit, its impact is not sustained, and any potential risk remains minimal. Additionally, Table 4 shows no statistically significant differences between the two groups in terms of OHSS incidence or associated symptoms, including transvaginal sonography findings, nausea, abdominal distention, and pain. The calculated odds ratios and p-values support the conclusion that neither treatment demonstrated clear superiority in preventing OHSS or improving related clinical symptoms in the early post-retrieval period. This trial has some limitations. One major limitation of this study is the small sample size, as it was designed as a pilot trial with only 42 participants. This limited statistical power restricts the ability to detect small but potentially meaningful differences in the efficacy of cabergoline and hydroxychloroquine. Additionally, the small number of OHSS cases observed on Day 5 limits the ability to detect meaningful differences between treatment groups at this time point. This low event rate reduces the statistical power of the analysis and may mask potential variations in efficacy. As such, the findings should be considered preliminary, and larger, adequately powered studies are necessary to validate and expand upon these results. Besides, pregnancy rates and live birth rates were not evaluated. Although the exact mechanisms remain primarily theoretical, our findings suggest that hydroxychloroquine warrants further investigation as a potential preventive therapy for OHSS. Conclusion This pilot randomized clinical trial suggests that both cabergoline and hydroxychloroquine may help prevent OHSS in PCOS patients, with no significant differences in efficacy observed in this small sample. However, given the limited sample size and the low incidence of OHSS, these findings should be interpreted with caution. The study lacks the statistical power to make definitive conclusions or generalize to a larger population. Further research with a larger sample size is warranted to better understand the relative efficacy of cabergoline and hydroxychloroquine in preventing OHSS. Abbreviations Ovarian hyperstimulation syndrome (OHSS) in vitro fertilisation (IVF) Intracytoplasmic sperm injection (ICSI) human chorionic gonadotropin (hCG) Body Mass Index (BMI) Polycystic ovary syndrome (PCOS) Antral follicle count (AFC) anti-Müllerian hormone (AMH) Ovarian stimulation (OS) controlled ovarian stimulation (COS) Follicle-stimulating hormone (FSH) Assisted reproductive technology (ART) Systemic lupus erythematosus (SLE) Antral follicle count (AFC) Blood urea nitrogen (BUN) Luteinizing hormone (LH) Prolactin (PRL) Hemoglobin (Hb) Hematocrit (HCT) Sodium (Na) Potassium (K) Creatinine (Cr) Alanine transaminase (ALT) Aspartate Transferase (AST) Number Needed to Treat (NNT) Number Needed to Harm (NNH) Confidence intervals (CI) Absolute risk reduction (ARR) Absolute risk increase (ARI) Odds ratio (OR) Declarations Author Contributions Conceptualization: ES, LK, AM Data curation: KJ Formal analysis: KJ Investigation: ES Methodology: ES, KJ Project administration: ES Software: N/A Supervision: AM Validation: N/A Visualization: NAA Writing – original draft: NAA, ES, KJ Writing – review & editing: NAA, ES, KJ, LK, AM All authors read and approved the final version. Acknowledgments The authors would like to thank Arash Women’s Hospital’s staff for their help. Data availability Data is provided within the manuscript. Funding No funding. Human ethics and consent to participate declarations This study followed the principles outlined in the Declaration of Helsinki. The Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran, approved the study (Ethics Code: IR.TUMS.MEDICINE.REC.1402.699; 2024 March 04). After receiving the necessary information, all participants read and signed the informed consent. Consent for publication Not Applicable. Conflicts of interest disclosures The authors declare that they have no competing interests. References Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657–63. Golan A, RON-EL R, HERMAN A, SOFFER Y. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44(6):430–40. Haas J, Yinon Y, Meridor K, Orvieto R. Pregnancy outcome in severe OHSS patients following ascitic/plerural fluid drainage. J Ovarian Res. 2014;7:1–4. Nouri K, Haslinger P, Szabo L, Sator M, Schreiber M, Schneeberger C, et al. Polymorphisms of VEGF and VEGF receptors are associated with the occurrence of ovarian hyperstimulation syndrome (OHSS)—a retrospective case–control study. J ovarian Res. 2014;7:1–7. Goldsman MP, Pedram A, Dominguez CE, Ciuffardi I, Levin E, Asch RH. Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome. Fertil Steril. 1995;63(2):268–72. Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet. 2010;27:121–8. Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, et al. Factors associated with ovarian hyperstimulation syndrome (OHSS) severity in women with polycystic ovary syndrome undergoing IVF/ICSI. Front Endocrinol. 2021;11:615957. Humaidan P, Nelson S, Devroey P, Coddington C, Schwartz L, Gordon K, et al. Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Hum Reprod. 2016;31(9):1997–2004. Schirmer DA III, Kulkarni AD, Zhang Y, Kawwass JF, Boulet SL, Kissin DM. Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes. Fertil Steril. 2020;114(3):567–78. Shmorgun D, Claman P, Gysler M, Hemmings R, Cheung AP, Goodrow GJ, et al. The diagnosis and management of ovarian hyperstimulation syndrome. J Obstet Gynecol Can. 2011;33(11):1156–62. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res. 2017;151:S61–4. Zhang H-M, Yao B, Li L, Guo S-S, Deng H-Y, Ren Y-P. Causal relationship between OHSS and immune cells: A Mendelian randomization study. J Reprod Immunol. 2024;165:104314. Eden J, Place J, Carter G, Alaghband-Zadeh J, Pawson M. Is the polycystic ovary a cause of infertility in the ovulatory woman? Clin Endocrinol. 1989;30(1):77–82. Homburg R. Polycystic ovary syndrome—from gynaecological curiosity to multisystem endocrinopathy. Hum Reprod. 1996;11(1):29–39. Pundir J, Sunkara SK, El-Toukhy T, Khalaf Y. Meta-analysis of GnRH antagonist protocols: do they reduce the risk of OHSS in PCOS? Reproductive biomedicine online. 2012;24(1):6–22. Leitao VM, Moroni RM, Seko LM, Nastri CO, Martins WP. Cabergoline for the prevention of ovarian hyperstimulation syndrome: systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2014;101(3):664–75. e7. Palomba S, Costanzi F, Nelson SM, Caserta D, Humaidan P. Interventions to prevent or reduce the incidence and severity of ovarian hyperstimulation syndrome: a systematic umbrella review of the best clinical evidence. Reproductive Biology Endocrinol. 2023;21(1):67. Palomba S, Costanzi F, Nelson SM, Besharat A, Caserta D, Humaidan P. Beyond the umbrella: a systematic review of the interventions for the prevention of and reduction in the incidence and severity of ovarian hyperstimulation syndrome in patients who undergo in vitro fertilization treatments. Int J Mol Sci. 2023;24(18):14185. Soares SR, Gómez R, Simón C, García-Velasco JA, Pellicer A. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Update. 2008;14(4):321–33. Huybrechts KF, Bateman BT, Zhu Y, Straub L, Mogun H, Kim SC, et al. Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol. 2021;224(3):290. e1-. e22. Rahman RA, Murthi P, Singh H, Gurungsinghe S, Leaw B, Mockler JC, et al. Hydroxychloroquine mitigates the production of 8-isoprostane and improves vascular dysfunction: implications for treating preeclampsia. Int J Mol Sci. 2020;21(7):2504. Abd Rahman R, DeKoninck P, Murthi P, Wallace EM. Treatment of preeclampsia with hydroxychloroquine: a review. J Maternal-Fetal Neonatal Med. 2018;31(4):525–9. Torigoe M, Sakata K, Ishii A, Iwata S, Nakayamada S, Tanaka Y. Hydroxychloroquine efficiently suppresses inflammatory responses of human class-switched memory B cells via Toll-like receptor 9 inhibition. Clin Immunol. 2018;195:1–7. Shukla AM, Bose C, Karaduta OK, Apostolov EO, Kaushal GP, Fahmi T, et al. Impact of hydroxychloroquine on atherosclerosis and vascular stiffness in the presence of chronic kidney disease. PLoS ONE. 2015;10(9):e0139226. Virdis A, Tani C, Duranti E, Vagnani S, Carli L, Kühl AA, et al. Early treatment with hydroxychloroquine prevents the development of endothelial dysfunction in a murine model of systemic lupus erythematosus. Arthritis Res therapy. 2015;17:1–9. Mathur R, Jenkins J, Bansal A. The possible role of the immune system in the aetiopathogenesis of ovarian hyperstimulation syndrome. Hum Reprod (Oxford England). 1997;12(12):2629–34. Farkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, et al. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res. 2020;13:1–8. Abramov Y, Schenker J, Lewin A, Friedler S, Nisman B, Barak V. Endocrinology: plasma inflammatory cytokines correlate to the ovarian hyperstimulation syndrome. Hum Reprod. 1996;11(7):1381–6. Orvieto R. Controlled ovarian hyperstimulation—an inflammatory state. J Soc Gynecologic Investigation: JSGI. 2004;11:424–6. Wakiya R, Ueeda K, Nakashima S, Shimada H, Kameda T, Mansour MMF, et al. Effect of add-on hydroxychloroquine therapy on serum proinflammatory cytokine levels in patients with systemic lupus erythematosus. Sci Rep. 2022;12(1):10175. Routy JP, Angel J, Patel M, Kanagaratham C, Radzioch D, Kema I, et al. Assessment of chloroquine as a modulator of immune activation to improve CD4 recovery in immune nonresponding HIV-infected patients receiving antiretroviral therapy. HIV Med. 2015;16(1):48–56. Yacoub S, Cadesky K, Casper RF. Low risk of OHSS with follitropin delta use in women with different polycystic ovary syndrome phenotypes: a retrospective case series. J Ovarian Res. 2021;14:1–6. Salmassi A, Mettler L, Hedderich J, Jonat W, Deenadayal A, Von Otte S, et al. Cut-off levels of anti-mullerian hormone for the prediction of ovarian response, in vitro fertilization outcome and ovarian hyperstimulation syndrome. Int J Fertility Steril. 2015;9(2):157. Group REASPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7. Golan A, Weissman A. A modern classification of OHSS. Reprod Biomed Online. 2009;19(1):28–32. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Statistics: J Appl Stat Pharm Ind. 2005;4(4):287–91. Álvarez C, Martí-Bonmatí L, Novella-Maestre E, Sanz R, Gomez R, Fernandez-Sanchez M, et al. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. J Clin Endocrinol Metabolism. 2007;92(8):2931–7. Garcia-Velasco JA, Pellicer A. New concepts in the understanding of the ovarian hyperstimulation syndrome. Curr Opin Obstet Gynecol. 2003;15(3):251–6. Fouda UM, Sayed AM, Elshaer HS, Hammad BEM, Shaban MM, Elsetohy KA, et al. GnRH antagonist rescue protocol combined with cabergoline versus cabergoline alone in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial. J Ovarian Res. 2016;9:1–8. Youssef MA, Van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459–66. Tang H, Mourad SM, Wang A, Zhai S-D, Hart RJ. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Reviews. 2021(4). Kilic N, Özdemir Ö, Başar HC, Demircan F, Ekmez F, Yücel O. Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoingin vitro fertilization/intracytoplasmic sperm injection treatment cycles: a randomized controlled study. Avicenna J Med. 2015;5(04):123–7. Papaleo E, Doldi N, De Santis L, Marelli G, Marsiglio E, Rofena S, et al. Cabergoline influences ovarian stimulation in hyperprolactinaemic patients with polycystic ovary syndrome. Hum Reprod. 2001;16(11):2263–6. Torabizadeh A, Vahidroodsari F, Ghorbanpour Z. Comparison of albumin and cabergoline in the prevention of ovarian hyperstimulation syndrome: A clinical trial study. Iran J reproductive Med. 2013;11(10):837. Naghshineh E, Khani B, Mesgari L. The efficiency of gnrh antagonist (cetrotide) in comparison of cabergoline in the prevention and treatment of ovarian hyperstimulation syndrome. J Isfahan Med School. 2021;38(606):982–8. Fouda UM, Elshaer HS, Youssef GG, Hanafy A, Mehrem WM, Youssef MA, et al. Cabergoline versus calcium infusion in the prevention of ovarian hyperstimulation syndrome: a randomised controlled study. J Obstet Gynaecol. 2022;42(1):122–6. Ghasemnejad-Berenji H, Novin MG, Hajshafiha M, Nazarian H, Hashemi S, Ilkhanizadeh B, et al. Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure. Biomed Pharmacother. 2018;107:1277–85. Yang J, Yang X, Yang J, Li M. Hydroxychloroquine inhibits the differentiation of Th17 cells in systemic lupus erythematosus. J Rhuematol. 2018;45(6):818–26. Willis R, Seif A, McGwin G Jr, Martinez-Martinez L, González E, Dang N, et al. Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort. Lupus. 2012;21(8):830–5. Costedoat-Chalumeau N, Amoura Z, Duhaut P, Huong DLT, Sebbough D, Wechsler B, et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty‐three cases compared with a control group. Arthr Rhuem. 2003;48(11):3207–11. Buchanan N, Toubi E, Khamashta MA, Lima F, Kerslake S, Hughes G. Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases. Ann Rheum Dis. 1996;55(7):486–8. Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheumatism: Official J Am Coll Rheumatol. 2006;54(11):3640–7. Cooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM, et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol. 2014;66(2):444–50. Beksac MS, Donmez HG. Impact of hydroxychloroquine on the gestational outcomes of pregnant women with immune system problems that necessitate the use of the drug. J Obstet Gynecol Res. 2021;47(2):570–5. Schreiber K, Hunt BJ. Managing antiphospholipid syndrome in pregnancy. Thromb Res. 2019;181:S41–6. Sperber K, Hom C, Chao CP, Shapiro D, Ash J. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol. 2009;7:1–9. Sadeghpour S, Ghasemnejad Berenji M, Nazarian H, Ghasemnejad T, Nematollahi MH, Abroon S, et al. Effects of treatment with hydroxychloroquine on the modulation of Th17/Treg ratio and pregnancy outcomes in women with recurrent implantation failure: clinical trial. Immunopharmacol Immunotoxicol. 2020;42(6):632–42. Moini A, Sepidarkish M, Dehpour AR, Rabiei M, Abiri A, Pirjani R. The effect of hydroxychloroquine on pregnancy outcomes in patients with unexplained recurrent pregnancy loss: a placebo-controlled study pilot study. J Obstet Gynaecol. 2022;42(8):3471–6. Mirzaei M, Amirajam S, Moghimi ES, Behzadi S, Rohani A, Zerangian N, et al. The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis. J Med Life. 2023;16(2):189. Ye S, Liu Y, Zhao X, Ma Y, Wang Y. Hydroxychloroquine improves pregnancy outcomes of women with positive antinuclear antibody spectrum test results. Front Med. 2023;10:1113127. de Moreuil C, Alavi Z, Pasquier E. Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage. Br J Clin Pharmacol. 2020;86(1):39–49. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 May, 2025 Read the published version in Journal of Ovarian Research → Version 1 posted Editorial decision: Revision requested 11 May, 2025 Reviews received at journal 13 Apr, 2025 Reviewers agreed at journal 13 Apr, 2025 Reviewers invited by journal 12 Apr, 2025 Submission checks completed at journal 11 Apr, 2025 First submitted to journal 09 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5855263","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":442284869,"identity":"e7d38dc3-8d3f-4a96-b432-e33c5d9e607c","order_by":0,"name":"Elnaz Salari","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran","correspondingAuthor":false,"prefix":"","firstName":"Elnaz","middleName":"","lastName":"Salari","suffix":""},{"id":442284870,"identity":"58ef446f-14b3-4478-bda3-37206c8a2547","order_by":1,"name":"Negar Ajabi Ardehjani","email":"","orcid":"","institution":"Department of Anatomical Sciences, School of Medicine, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran, Iran, Islamic Republic Of","correspondingAuthor":false,"prefix":"","firstName":"Negar","middleName":"Ajabi","lastName":"Ardehjani","suffix":""},{"id":442284871,"identity":"eb2ef6c2-64af-408a-8457-dd031a9f042b","order_by":2,"name":"Ladan Kashani","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran","correspondingAuthor":false,"prefix":"","firstName":"Ladan","middleName":"","lastName":"Kashani","suffix":""},{"id":442284872,"identity":"473aace8-e18c-4e45-83c1-f40e702293d1","order_by":3,"name":"Kasra Jafari","email":"","orcid":"","institution":"Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran","correspondingAuthor":false,"prefix":"","firstName":"Kasra","middleName":"","lastName":"Jafari","suffix":""},{"id":442284874,"identity":"79a2b55e-6033-4c28-af73-6955f3280761","order_by":4,"name":"Ashraf Moini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYLCCBAYJOQjLAIiZidRiDNfCwwzUc4AIXYkNMBYPAwEt/A3ciQ8e7rBI397eY/i5oOCOvT07/zHpDxUMcub9C7BqkTjAu9kg8YxE7pwzZ4ylZxg8S+xhZmaTOHCGwVjmxgPs1hzg3SaR2CaRO0Mix0Cax+BwAg9Iy8E2hsQZEtidJw/Vki4hkWP8G6jFHqLlH24tBlAtCUAtZiBbGMEOO9gA1MLfgFWLIdgvbRKGM3iOlVkDtST2HGY2tjhzTMJYQgK7V+QO8G58+LOtTl6CvXnzbZ4/h+3Z+w8+vFFRYyMnwY/dYQzy8GDhMEAWB1ohkYBdCwKwP0ATwGXLKBgFo2AUjDQAABKOVQuvMWIjAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran","correspondingAuthor":true,"prefix":"","firstName":"Ashraf","middleName":"","lastName":"Moini","suffix":""}],"badges":[],"createdAt":"2025-01-18 13:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5855263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5855263/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13048-025-01702-6","type":"published","date":"2025-05-29T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80789703,"identity":"9644e778-ae47-4e6b-abaf-676b2047346a","added_by":"auto","created_at":"2025-04-17 06:36:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178820,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant enrollment, randomization, and follow-up\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5855263/v1/949ad0f4c5653a011eacff43.png"},{"id":83783059,"identity":"bb74fe1d-88e5-4acd-ab07-a23ddaad4304","added_by":"auto","created_at":"2025-06-02 16:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1828588,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5855263/v1/a6de1e86-c38b-4a60-9272-46f298c75d8f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Study of Cabergoline and Hydroxychloroquine to Prevent Ovarian Hyperstimulation Syndrome (OHSS) in PCOS Patients: A Pilot Randomized Clinical Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOvarian hyperstimulation syndrome (OHSS), a potentially life-threatening condition, is the most severe iatrogenic side effect of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. The incidence of moderate to severe OHSS is predicted to be between 1% and 5% in all IVF cycles (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). OHSS is characterized by ovarian hypertrophy and fluid shift from intravascular to extravascular compartments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). OHSS has two common pathologies: (i) increased vascular permeability, and (ii) human chorionic gonadotropin (hCG) is the triggering element for this syndrome (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additionally, this condition is characterized by overproduction of pro-inflammatory and vasoactive cytokines (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Pretreatment risk factors for OHSS include young age (\u0026lt;\u0026thinsp;30 years), low body mass index (BMI), polycystic ovary syndrome (PCOS) or high basal antral follicle count (AFC), a history of elevated response to gonadotrophins (e.g., prior hyper-response or OHSS), and high basal anti-M\u0026uuml;llerian hormone (AMH) concentrations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). During and after ovarian stimulation (OS), elevated or rapidly rising serum estradiol concentrations, a large number of small follicles (8\u0026ndash;12 mm), the use of hCG instead of progesterone for luteal phase support after IVF, a large number of oocytes retrieved (\u0026gt;\u0026thinsp;20), and pregnancy following fresh embryo transfer are associated with an increased risk of OHSS (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The clinical diagnosis of OHSS has been classified into mild, moderate, severe, and critical forms (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Criteria for diagnosing moderate to severe OHSS include symptoms such as nausea (with or without vomiting), clinically or ultrasound-detected ascites, hydrothorax, reduced urine output (oliguria), a hematocrit level over 45%, low protein levels (hypoproteinemia), and ovarian size greater than 8 mm (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs mentioned earlier, OHSS often results from an exaggerated ovarian response to hormonal stimulation, particularly in high-risk groups such as patients with PCOS. PCOS is the most common cause of anovulatory infertility and a primary reason for undergoing assisted reproductive technology (ART) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Patients with PCOS have larger follicles, longer follicular phases, and higher median follicular concentrations of LH, FSH, and testosterone than ovulatory women with normal ovaries (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). During ovarian stimulation, women with PCOS respond to gonadotropins with extensive follicular development and a rapid surge in circulating estradiol. Additionally, the high sensitivity of polycystic ovaries to controlled ovarian stimulation (COS) makes controlling COS in patients with PCOS particularly challenging (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Thus, preventing OHSS is a primary goal in reproductive therapy for these patients, necessitating individualized ovarian stimulation protocols and continuous monitoring (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Several approaches have been introduced to lower the risk of moderate to severe OHSS (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These approaches may change the stimulation protocol. These include replacing follicle-stimulating hormone (FSH) with low-dose hCG, employing GnRH antagonists instead of GnRH agonists during IVF, using a GnRH agonist instead of hCG to trigger final follicular maturation, and coasting and incorporating follitropin delta in GnRH-ant IVF cycles (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, post-stimulation interventions, such as the administration of a GnRH antagonist after oocyte retrieval and cabergoline after the end of COS, were employed. Other strategies, such as cycle cancellation, freezing all embryos, and in vitro oocyte maturation, may also help reduce OHSS risk. However, aside from cycle cancelation, none of these interventions have been completely effective in preventing OHSS due to variations in efficacy and safety outcomes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCabergoline, a D2 dopamine receptor agonist, effectively controls vascular permeability by inhibiting VEGFR2 phosphorylation. Several studies have explored its use in OHSS prevention, employing various doses and treatment regimens (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This strategy is feasible for all women who are undergoing COS, with no evidence suggesting it impairs implantation (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Hydroxychloroquine, an antimalarial drug, is also employed to address infertility on an immunologic basis and is widely prescribed for individuals with autoimmune diseases, mainly systemic lupus erythematosus (SLE) and other rheumatic conditions (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Hydroxychloroquine exerts complex pleiotropic effects on multiple cell types. It reduces the production of pro-inflammatory cytokines, such as TNF-α, IFN-γ, IL-6, and IL-8, decreasing platelet aggregation. It also inhibits T follicular helper (Tfh) cells, suppresses toll-like receptor (TLR) activation, influences antigen-antibody interactions, and inhibits the release of endothelin-1 (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Hydroxychloroquine also benefits vascular compliance and helps prevent endothelial dysfunction (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Notably, several studies highlight the involvement of various cytokines in OHSS, suggesting interactions between systemic inflammatory cytokines such as IL-2, IL-6, IL-8, IL-10, IL-18, TNF-α, and VEGF and the pathophysiology of OHSS (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Due to its immunomodulatory mechanism and ability to reduce systemic inflammation (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), hydroxychloroquine may also have potential utility in the prevention of OHSS; however, the precise mechanism in this space is still not completely clear.\u003c/p\u003e \u003cp\u003eA key challenge for fertility specialists is preventing complications while striking a balance between effective ovarian stimulation for a successful outcome and minimizing the patient\u0026rsquo;s risk of OHSS. As a result, doctors must carefully estimate the initial gonadotropin dose to generate the maximum number of oocytes while minimizing the risk of OHSS (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Based on this, we hypothesize that hydroxychloroquine, like cabergoline, may confer beneficial effects in women at high risk of OHSS, particularly those with PCOS.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eTrial Design and Setting\u003c/p\u003e \u003cp\u003eThis study was a double-blind, parallel, and randomized clinical trial. It was conducted from April 03, 2024, to June 21, 2024, on women with PCOS who were candidates for ART at Arash Women\u0026rsquo;s Hospital, a tertiary hospital affiliated with Tehran University of Medical Sciences, Tehran, Iran.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e This study followed the principles outlined in the Declaration of Helsinki. The Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran, approved the study (Ethics Code: IR.TUMS.MEDICINE.REC.1402.699; 2024 March 04). Additionally, this study was registered on the Iranian clinical trial registry (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.irct.ir\u003c/span\u003e\u003cspan address=\"http://www.irct.ir\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; Registration number: IRCT20240305061171N1; Registration date: 2024 June 29). All individuals provided informed consent.\u003c/p\u003e \u003cp\u003eEligibility Criteria\u003c/p\u003e \u003cp\u003ePatients with PCOS who were undergoing ICSI and were aged 22\u0026ndash;42 years, with BMI\u0026thinsp;\u0026lt;\u0026thinsp;30 kg/m\u0026sup2;, AFC\u0026thinsp;\u0026gt;\u0026thinsp;20, and AMH levels\u0026thinsp;\u0026gt;\u0026thinsp;3.36 ng/ml (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) were included in the study. Women diagnosed with PCOS according to the Rotterdam criteria (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), including at least two of the three following criteria: oligomenorrhea or amenorrhea, hyperandrogenism biochemical or clinical evidence, and ovarian morphology.\u003c/p\u003e \u003cp\u003ePatients with the diagnosis of endometriosis, reduced ovarian reserve, chromosomal abnormalities, history of allergy to dopamine agonists or cabergoline, and failure to adhere to the prescribed medication regimen were excluded from the study.\u003c/p\u003e \u003cp\u003eRecruitment and Baseline Assessment\u003c/p\u003e \u003cp\u003eAll the participants were recruited from patients referred to Arash Women\u0026rsquo;s Hospital. We recruited participants via conversations, and interested patients received detailed information about the study. After checking the eligibility criteria, the baseline assessment involved demographic characteristics (age, BMI, menstrual cycle regularity, and infertility type and factors) and hormonal profiles of patients (including serum levels of FSH, luteinizing hormone (LH), prolactin (PRL), progesterone, estradiol, testosterone, vitamin D, and anti-M\u0026uuml;llerian hormone (AMH)), and ultrasounds were evaluated.\u003c/p\u003e \u003cp\u003eRandomization, Concealment, and Blinding\u003c/p\u003e \u003cp\u003eParticipants were allocated randomly into one of the two arms at a ratio of 1:1 on the trigger day. The sequence was created by generating a block size of 4. The sequence of people in the randomized list was only available to an external observer responsible for participant allocation, and the researchers were not aware of it. A nurse selected and randomized the patients using a set of sequentially numbered, sealed opaque envelopes. The study was double-blinded since the physicians prescribed the interventions, physicians assessed the participantsfor the outcomes, and participants were blinded to the group allocation of the participants in the trial.\u003c/p\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003cp\u003eThe standard gonadotropin-releasing hormone antagonist (GnRH-ant) protocol was utilized for all patients. On the third day of the menstrual cycle, daily administration of 150 IU of rFSH (\u003cem\u003eCinal-F, Cinnagen, Iran\u003c/em\u003e) was initiated. During the protocol, ultrasonographic monitoring was performed, and the dose of rFSH was adjusted based on the progress of follicular development and patient response. After observing at least two 13 mm follicles, GnRH antagonist (\u003cem\u003eCetrotide 0.25 mg, Serpero, Switzerland\u003c/em\u003e) was administered via subcutaneous injection daily. When the dominant follicles reached a diameter of 18 mm, the final stage of oocyte maturation was induced with 0.2 mg of Decapeptyl (\u003cem\u003eDecapeptyl 0.2 mg, Ferring, Germany\u003c/em\u003e) as a trigger. Oocyte retrieval was performed 36 hours later. On the trigger day, one group received 0.5 mg of cabergoline (\u003cem\u003eCaberlin, Iranhormone, Iran\u003c/em\u003e), while the other group simultaneously administered 400 mg (2 \u0026times; 200 mg tablets) of hydroxychloroquine (\u003cem\u003eHydroxychloroquine sulfate, Rouzdarou, Iran\u003c/em\u003e) for 8 days. In this study, the Freeze-all strategy was employed for all embryos. Clinical symptoms, laboratory tests, and ultrasounds were conducted on days 3 and 5 after the pickup procedure to assess for OHSS.\u003c/p\u003e \u003cp\u003eOutcome Measurements\u003c/p\u003e \u003cp\u003eOn the third and fifth days following oocyte retrieval, OHSS was diagnosed, and its severity was determined using Golan's classification (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Mild OHSS is defined as abdominal pain, nausea, and ovarian enlargement (8\u0026ndash;12 cm) detected via ultrasound, with small amounts of fluid in the pelvis. Moderate OHSS is defined as more extensive ascites and nausea or vomiting requiring hospital admission. Severe OHSS is defined as significant fluid accumulation in the abdomen or thorax, shortness of breath, hematocrit\u0026thinsp;\u0026gt;\u0026thinsp;55%, electrolyte imbalances, elevated blood urea nitrogen (BUN)/creatinine, reduced urine output, or kidney failure (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). At each visit, the patient's vital signs and weight were taken. A transvaginal ultrasound (\u003cem\u003ePhilips Affiniti 70, Philips, Netherlands\u003c/em\u003e) was performed to determine the ovarian volume and estimate the volume of pelvic free fluid. Data were obtained from the checklist, clinical and laboratory notes, and ultrasound reports. All patients were evaluated for cabergoline and hydroxychloroquine-related symptoms and side effects. Patients are also instructed to report any issues from day 8 until their next menstrual cycle.\u003c/p\u003e \u003cp\u003eSample size\u003c/p\u003e \u003cp\u003eSince this was a pilot randomized clinical trial aimed primarily at assessing feasibility and generating preliminary data rather than testing a formal hypothesis, we determined the sample size based on the commonly used rule of thumb for pilot studies (typically 12 participants per arm) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Also, no prior studies have evaluated the effect of hydroxychloroquine on OHSS, so this pilot study was designed with a sample size of 21 patients per group.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Stata version 17.0 and P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant differences. The normality of data distribution was evaluated using the Shapiro-Wilk test, skewness, kurtosis indices, as well as histograms and boxplots. To compare continuous variables, we used the Student's t-test (or its non-parametric alternative, the Mann-Whitney test), and for categorical variables, we used the Chi-square test (or Fisher's exact test). To evaluate the clinical effectiveness and safety of the intervention, we calculated the Number Needed to Treat (NNT) and Number Needed to Harm (NNH) along with their corresponding 95% confidence intervals (CIs). The NNT was derived as the reciprocal of the absolute risk reduction (ARR) between the intervention and control groups for incidence of any severity of OHSS:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:NNT=\\:\\frac{1}{{Risk}_{\\text{c}\\text{a}\\text{b}\\text{e}\\text{r}\\text{g}\\text{o}\\text{l}\\text{i}\\text{n}\\text{e}\\:\\text{g}\\text{r}\\text{o}\\text{u}\\text{p}\\:}-\\:{Risk}_{\\text{h}\\text{y}\\text{d}\\text{r}\\text{o}\\text{x}\\text{y}\\text{c}\\text{h}\\text{l}\\text{o}\\text{r}\\text{o}\\text{q}\\text{u}\\text{i}\\text{n}\\text{e}\\:\\text{g}\\text{r}\\text{o}\\text{u}\\text{p}\\:}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSimilarly, for adverse outcomes, NNH was calculated as the reciprocal of the absolute risk increase (ARI) for incidence of any severity ofOHSS:​\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:NNH=\\:\\frac{1}{{Risk}_{\\text{h}\\text{y}\\text{d}\\text{r}\\text{o}\\text{x}\\text{y}\\text{c}\\text{h}\\text{l}\\text{o}\\text{r}\\text{o}\\text{q}\\text{u}\\text{i}\\text{n}\\text{e}\\:\\text{g}\\text{r}\\text{o}\\text{u}\\text{p}\\:}-\\:{Risk}_{\\text{c}\\text{a}\\text{b}\\text{e}\\text{r}\\text{g}\\text{o}\\text{l}\\text{i}\\text{n}\\text{e}\\:\\text{g}\\text{r}\\text{o}\\text{u}\\text{p}\\:}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eAdditionally, odds ratios (ORs) and their 95% CIs were calculated using logistic regression to estimate the association between treatment group and binary outcomes. Due to the small number of outcomes, variables were analyzed as binary (presence/absence).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eInitially, 44 participants were screened, and 2 (4.5%) were subsequently excluded. The remaining 42 (95.4%) participants were randomly assigned to either the 50% cabergoline group (n\u0026thinsp;=\u0026thinsp;21) or the 50% hydroxychloroquine group (n\u0026thinsp;=\u0026thinsp;21). During the study, two participants in the hydroxychloroquine group withdrew from the trial as they failed to attend the follow-up visits after the second visit on day five post-trigger (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\n\u003cp\u003eThe baseline demographic, clinical, and laboratory characteristics of participants in the cabergoline (n=21) and hydroxychloroquine (n=19) groups were comparable (Table 1). The mean age was 32.09\u0026plusmn;4.10 years in the cabergoline group and 29.58\u0026plusmn;4.78 years in the hydroxychloroquine group (p=0.113). Mean BMI, menstrual cycle regularity, and infertility type and factors showed no significant differences between the groups. Baseline laboratory parameters, including FSH, LH, AMH, and others, were similar across groups. Only the right AFC was slightly higher in the hydroxychloroquine group (p-value = 0.037).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e \u003cstrong\u003eBaseline characteristics of the participants.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydroxychloroquine\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCabergoline\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic and Clinical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e30.90 (5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e29.58 (4.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e32.10 (5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e27.08 (5.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e25.88 (4.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e28.17 (5.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegular menstrual cycle (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e15 (37.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e7 (36.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (38.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e24 (60.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e12 (63.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12 (57.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOligomenorrhea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1 (2.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary infertility (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e11 (27.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 (31.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5 (23.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e29 (72.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e13 (68.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e16 (76.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary infertility (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e30 (75.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e13 (68.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e17 (80.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e10 (25.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 (31.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (19.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale factor infertility (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e4 (10.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e36 (90.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e17 (89.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e19 (90.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFSH (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.21 (1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e5.33 (2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5.11 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLH (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.47 (2.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e5.46 (2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5.48 (2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMH (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.84 (3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6.36 (4.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5.38 (3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTSH \u0026nbsp;(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.07 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1.81 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2.31 (0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRL (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e134.11 (143.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e118.89 (117.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e148.56 (165.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgesterone (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e4.75 (6.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e5.51 (7.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.07 (4.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstradiol (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e36.03 (36.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e31.83 (34.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e39.84 (37.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin D (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e27.50 (11.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e29.89 (14.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e25.34 (7.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTestosterone (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e17.86 (18.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e14.95 (19.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e20.48 (17.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSonographic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFC right (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e12.83 (2.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e13.69 (2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12.15 (1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAFC left (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e13.33 (2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e13.69 (2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e13.05 (1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrigger Day a-GNRH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgesterone (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1.25 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1.19 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1.30 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstradiol (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2100.60 (466.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2187.74 (441.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2021.76 (484.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrigger Cycle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003erFSH cinal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e150\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e10 (25.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e7 (36.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3 (14.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e225\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e24 (60.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e9 (47.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e15 (71.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e300\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Body mass index (BMI), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Anti-m\u0026uuml;llerian hormone (AMH), Prolactin (PRL), Antral follicle count (AFC).\u003c/p\u003e\n\u003ch2\u003ePost-Intervention Laboratory Parameters and Outcomes\u003c/h2\u003e\n\u003cp\u003eThree days after oocyte retrieval, laboratory findings and outcomes were broadly similar between groups (Table 2). Key laboratory parameters, such as hemoglobin, hematocrit, sodium, potassium, BUN, and creatinine, did not significantly differ between the cabergoline and Hydroxychloroquine groups (p\u0026gt;0.05 for all). Reported side effects, including nausea, vomiting, abdominal distension, pain, and oliguria, were comparable. OHSS incidence did not significantly differ between groups, with mild and moderate cases evenly distributed. None of the patients in the cabergoline group required treatment for OHSS, compared to one (5.26%) patient of hydroxychloroquine patients, although this difference was not statistically significant (p=0.299).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e \u003cstrong\u003eLaboratory parameters, outcomes, and the side effects three days after pick up.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydroxychloroquine\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCabergoline\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e11.87 (1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11.86 (1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11.89 (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCT (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e35.92 (2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e36.22 (3.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e35.64 (2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNa (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e140.43 (1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e140.74 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e140.14 (2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.08 (0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.07 (0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.09 (0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUN (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e10.33 (3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9.36 (2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11.20 (4.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCr (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.85 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.85 (0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.85 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e21.05 (10.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18.63 (6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23.24 (12.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e19.70 (7.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18.26 (6.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21.00 (9.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALK (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e133.73 (28.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e129.79 (29.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e137.29 (27.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Outcomes and Side Effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransvaginal \u0026nbsp;sonography (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e15 (37.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (42.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e18 (45.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9 (47.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9 (42.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e7 (17.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5 (23.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e20 (50.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (52.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e16 (40.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (31.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVomiting (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal distention (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e20 (50.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (52.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e17 (42.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (36.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal pain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e18 (45.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (42.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e17 (42.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (42.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9 (42.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e5 (12.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (15.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOliguria (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e33 (82.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 (84.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e17 (80.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e5 (12.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (15.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyspnea (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOHSS (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e20 (50.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (52.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10 (47.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e15 (37.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (31.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9 (42.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e5 (12.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (15.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment for OHSS (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e39 (97.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21 (100.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (89.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21 (100.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment hospitalization (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e37 (92.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (89.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Hemoglobin (Hb), Hematocrit (HCT), Sodium (Na), Potassium (K), Blood urea nitrogen (BUN), Creatinine (Cr), Alanine transaminase (ALT), Aspartate Transferase (AST), Ovarian hyperstimulation syndrome (OHSS).\u003c/p\u003e\n\u003cp\u003eFive days post-retrieval, laboratory parameters remained comparable (Table 3). Incidence of OHSS was low and similar between groups, with mild cases reported in one of patients in both groups (p=0.942). Side effects, including abdominal pain and distension, were reported at low rates and did not differ significantly. Other side effects were not observed in both of the groups.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the incidence of OHSS and side effect profiles were similar between cabergoline and hydroxychloroquine, with no significant differences observed in laboratory parameters or clinical outcomes after oocyte retrieval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Laboratory parameters, outcomes, and the side effects five days after pick up.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N=40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydroxychloroquine\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCabergoline\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12.30 (1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e12.26 (1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e12.33 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCT (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37.37 (2.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e37.26 (3.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e37.47 (1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNa (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e140.00 (1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e140.11 (1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e139.90 (1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eK (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.02 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e4.04 (0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.00 (0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUN (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11.15 (2.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e10.42 (2.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e11.81 (3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCr (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.89 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.88 (0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.90 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31.38 (16.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e30.37 (19.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e32.29 (12.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28.10 (16.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e28.58 (21.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e27.67 (9.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALK (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e141.65 (31.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e137.21 (27.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e145.67 (34.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes and Side Effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransvaginal \u0026nbsp;sonography (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e36 (90.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e17 (89.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e19 (90.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 0px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (10.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2 (10.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal distention (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal pain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37 (92.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e19 (90.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2 (9.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOHSS (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38 (95.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e18 (94.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e20 (95.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (5.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1 (5.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1 (4.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Hemoglobin\u0026nbsp;(Hb), Hematocrit\u0026nbsp;(HCT), Sodium (Na), Potassium\u0026nbsp;(K), Blood urea nitrogen (BUN), Creatinine\u0026nbsp;(Cr), Alanine transaminase (ALT), Aspartate Transferase (AST), Ovarian hyperstimulation syndrome (OHSS).\u003c/p\u003e\n\u003cp\u003eOn Day 3, the NNT for hydroxychloroquine\u0026nbsp;versus cabergoline was 20, indicating that 20 patients would need to be treated with hydroxychloroquine\u0026nbsp;(rather than cabergoline) to prevent one additional case of OHSS. No significant harm (NNH) was observed at this time point. By Day 5, the effect of hydroxychloroquine\u0026nbsp;diminished, with no detectable preventive benefit (NNT not applicable). However, the NNH was 200, suggesting that 200 patients would need to receive hydroxychloroquine\u0026nbsp;(instead of cabergoline) to result in one additional case of OHSS, reflecting a minimal and clinically insignificant risk.\u003c/p\u003e\n\u003cp\u003eTable 4 presents the comparison of OHSS and clinical symptoms between the cabergoline and hydroxychloroquine groups on days 3 and 5 post-oocyte retrieval. The ORs and corresponding p-values indicate no statistically significant differences between the two groups for any of the assessed variables, including transvaginal\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esonography findings, nausea, abdominal distention, abdominal pain, and OHSS (all p-values \u0026gt; 0.05). These results suggest that neither cabergoline nor hydroxychloroquine demonstrated a superior effect in reducing the risk of OHSS or associated symptoms during the early post-retrieval period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of OHSS and clinical symptoms between cabergoline and hydroxychloroquine groups on days 3 and 5 after pick-up\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDay 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDay 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransvaginal \u0026nbsp; \u0026nbsp; Sonography\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.455 (0.402-5.260)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.895 (0.113-7.064)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.222 (0.353-4.235)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.900 (0.052-15.466)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal Distention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.222 (0.353-4.235)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.900 (0.052-15.466)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbdominal Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.800 (0.229-2.793)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.895 (0.158-22.751)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOHSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.222 (0.353-4.235)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e0.900 (0.052-15.466)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Odds ratio (OR), Ovarian hyperstimulation syndrome (OHSS).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized clinical trial evaluated the comparative effectiveness of cabergoline and hydroxychloroquine in preventing OHSS in patients with PCOS. In this study, patients were administered 0.5 mg of oral cabergoline daily, while another group was prescribed 400 mg of hydroxychloroquine for 8 days, starting on the trigger day. The findings presented in this study showed no statistically significant difference between the two groups in reducing the risk of OHSS in patients with PCOS at risk for developing OHSS.\u003c/p\u003e\u003cp\u003eCabergoline, a dopamine agonist, has been extensively studied for its ability to counteract the effects of vascular endothelial growth factor (VEGF), a key mediator in the increased vascular permeability seen in OHSS (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Several systematic reviews and meta-analyses have revealed that by reducing VEGF receptor-2 phosphorylation, dopaminergic agonists minimize excessive fluid buildup and successfully prevent moderate-severe OHSS (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In two studies, cabergoline effectively reduced OHSS risk in high-risk women undergoing IVF/ICSI (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Also, data suggest the use of cabergoline in the management of patients with PCOS to provide better clinical control of ovarian response and consequently a reduction of the risk of OHSS, with no decrease in pregnancy rate (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Several clinical trials have suggested the effectiveness of cabergoline as a preventive therapy for OHSS compared to alternative interventions such as albumin (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), cetrorelix (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), and calcium gluconate (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In line with our results, these studies suggest that cabergoline is an optimal strategy for reducing OHSS incidences in high-risk patients.\u003c/p\u003e\u003cp\u003eOur analysis shows that hydroxychloroquine is comparable to cabergoline in reducing the incidence of OHSS. Therefore, hydroxychloroquine is as effective as cabergoline in lowering the risk of OHSS in patients with PCOS who are at risk for developing OHSS. Numerous qualities of hydroxychloroquine, including its well-established safety profile and positive outcomes in long-term use, make it a promising candidate for clinical trials (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). A better understanding of the mechanisms of hydroxychloroquine's action has thus promoted recent advances in its therapeutic landscape. It has immunomodulatory and anti-inflammatory actions, which include enhancing Treg proliferation, suppressing pro-inflammatory cytokines, lysosomal membrane stabilization, and inhibition of phospholipase (\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). It is reasonable to hypothesize that hydroxychloroquine could mitigate the inflammatory aspects of OHSS. This study represents a novel exploration of hydroxychloroquine's potential role in this context. To our knowledge, this is the first study to investigate the potentiality of hydroxychloroquine treatment in managing OHSS in patients with PCOS. Research on the safety of hydroxychloroquine for treating malaria and rheumatic conditions, including SLE, indicates that it does not significantly increase the risk of common adverse pregnancy outcomes, such as miscarriage, preterm birth, or restricted fetal growth (\u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Additionally, a clinical study confirmed that hydroxychloroquine is safe for use during pregnancy in women with autoimmune disorders (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Some studies suggest that hydroxychloroquine has a potential role in improving reproductive outcomes in patients with autoimmune or inflammatory conditions (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Two clinical trials investigated the ability of hydroxychloroquine to modulate the immune system by the balance of pro-inflammatory and anti-inflammatory immune responses in women with repeated implantation failure (RIF) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Another trial study highlighted the protective effect of hydroxychloroquine in recurrent pregnancy loss (RPL) (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). A systematic review and meta-analysis have demonstrated that hydroxychloroquine administration may positively influence embryo transfer outcomes, including improved live birth and fertilization rates (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). A study has shown hydroxychloroquine's efficacy in improving adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Recent reports indicate that hydroxychloroquine is efficacious in improving adverse pregnancy outcomes (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). In line with previous studies, our findings suggest that hydroxychloroquine may be a suitable candidate for preventing OHSS in patients with PCOS.\u003c/p\u003e\u003cp\u003eOur findings showed that on Day 3 post-oocyte retrieval, hydroxychloroquine had a modest preventive effect compared to cabergoline, with an NNT of 20. This suggests that 20 patients would need to be treated with hydroxychloroquine instead of cabergoline to prevent one additional case of OHSS. Importantly, no harm was observed at this time point, as reflected by the absence of a calculable NNH. By Day 5, however, the preventive effect of hydroxychloroquine appeared to wane, with the NNT becoming non-applicable and the NNH rising to 200, indicating a very low risk of harm. These findings suggest that while hydroxychloroquine may offer some early benefit, its impact is not sustained, and any potential risk remains minimal. Additionally, Table\u0026nbsp;4 shows no statistically significant differences between the two groups in terms of OHSS incidence or associated symptoms, including transvaginal sonography findings, nausea, abdominal distention, and pain. The calculated odds ratios and p-values support the conclusion that neither treatment demonstrated clear superiority in preventing OHSS or improving related clinical symptoms in the early post-retrieval period.\u003c/p\u003e\u003cp\u003eThis trial has some limitations. One major limitation of this study is the small sample size, as it was designed as a pilot trial with only 42 participants. This limited statistical power restricts the ability to detect small but potentially meaningful differences in the efficacy of cabergoline and hydroxychloroquine. Additionally, the small number of OHSS cases observed on Day 5 limits the ability to detect meaningful differences between treatment groups at this time point. This low event rate reduces the statistical power of the analysis and may mask potential variations in efficacy. As such, the findings should be considered preliminary, and larger, adequately powered studies are necessary to validate and expand upon these results. Besides, pregnancy rates and live birth rates were not evaluated. Although the exact mechanisms remain primarily theoretical, our findings suggest that hydroxychloroquine warrants further investigation as a potential preventive therapy for OHSS.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot randomized clinical trial suggests that both cabergoline and hydroxychloroquine may help prevent OHSS in PCOS patients, with no significant differences in efficacy observed in this small sample. However, given the limited sample size and the low incidence of OHSS, these findings should be interpreted with caution. The study lacks the statistical power to make definitive conclusions or generalize to a larger population. Further research with a larger sample size is warranted to better understand the relative efficacy of cabergoline and hydroxychloroquine in preventing OHSS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOvarian hyperstimulation syndrome (OHSS)\u003c/p\u003e\u003cp\u003ein vitro fertilisation (IVF)\u003c/p\u003e\u003cp\u003eIntracytoplasmic sperm injection (ICSI)\u003c/p\u003e\u003cp\u003ehuman chorionic gonadotropin (hCG)\u003c/p\u003e\u003cp\u003eBody Mass Index (BMI)\u003c/p\u003e\u003cp\u003ePolycystic ovary syndrome (PCOS)\u003c/p\u003e\u003cp\u003eAntral follicle count (AFC)\u003c/p\u003e\u003cp\u003eanti-M\u0026uuml;llerian hormone (AMH)\u003c/p\u003e\u003cp\u003eOvarian stimulation (OS)\u003c/p\u003e\u003cp\u003econtrolled ovarian stimulation (COS)\u003c/p\u003e\u003cp\u003eFollicle-stimulating hormone (FSH)\u003c/p\u003e\u003cp\u003eAssisted reproductive technology (ART)\u003c/p\u003e\u003cp\u003eSystemic lupus erythematosus (SLE)\u003c/p\u003e\u003cp\u003eAntral follicle count (AFC)\u003c/p\u003e\u003cp\u003eBlood urea nitrogen (BUN)\u003c/p\u003e\u003cp\u003eLuteinizing hormone (LH)\u003c/p\u003e\u003cp\u003eProlactin (PRL)\u003c/p\u003e\u003cp\u003eHemoglobin (Hb)\u003c/p\u003e\u003cp\u003eHematocrit (HCT)\u003c/p\u003e\u003cp\u003eSodium (Na)\u003c/p\u003e\u003cp\u003ePotassium (K)\u003c/p\u003e\u003cp\u003eCreatinine (Cr)\u003c/p\u003e\u003cp\u003eAlanine transaminase (ALT)\u003c/p\u003e\u003cp\u003eAspartate Transferase (AST)\u003c/p\u003e\u003cp\u003eNumber Needed to Treat (NNT)\u003c/p\u003e\u003cp\u003eNumber Needed to Harm (NNH)\u003c/p\u003e\u003cp\u003eConfidence intervals (CI)\u003c/p\u003e\u003cp\u003eAbsolute risk reduction (ARR)\u003c/p\u003e\u003cp\u003eAbsolute risk increase (ARI)\u003c/p\u003e\u003cp\u003eOdds ratio (OR)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: ES, LK, AM\u003c/p\u003e\n\u003cp\u003eData curation: KJ\u003c/p\u003e\n\u003cp\u003eFormal analysis: KJ\u003c/p\u003e\n\u003cp\u003eInvestigation: ES\u003c/p\u003e\n\u003cp\u003eMethodology: ES, KJ\u003c/p\u003e\n\u003cp\u003eProject administration: ES\u003c/p\u003e\n\u003cp\u003eSoftware: N/A\u003c/p\u003e\n\u003cp\u003eSupervision: AM\u003c/p\u003e\n\u003cp\u003eValidation: N/A\u003c/p\u003e\n\u003cp\u003eVisualization: NAA\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: NAA, ES, KJ\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: NAA, ES, KJ, LK, AM\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Arash Women\u0026rsquo;s Hospital\u0026rsquo;s staff for their help.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed the principles outlined in the Declaration of Helsinki. The Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran, approved the study (Ethics Code: IR.TUMS.MEDICINE.REC.1402.699; 2024 March 04). After receiving the necessary information, all participants read and signed the informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest disclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolan A, RON-EL R, HERMAN A, SOFFER Y. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44(6):430\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas J, Yinon Y, Meridor K, Orvieto R. Pregnancy outcome in severe OHSS patients following ascitic/plerural fluid drainage. J Ovarian Res. 2014;7:1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNouri K, Haslinger P, Szabo L, Sator M, Schreiber M, Schneeberger C, et al. Polymorphisms of VEGF and VEGF receptors are associated with the occurrence of ovarian hyperstimulation syndrome (OHSS)\u0026mdash;a retrospective case\u0026ndash;control study. J ovarian Res. 2014;7:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldsman MP, Pedram A, Dominguez CE, Ciuffardi I, Levin E, Asch RH. Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome. Fertil Steril. 1995;63(2):268\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet. 2010;27:121\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, et al. Factors associated with ovarian hyperstimulation syndrome (OHSS) severity in women with polycystic ovary syndrome undergoing IVF/ICSI. Front Endocrinol. 2021;11:615957.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHumaidan P, Nelson S, Devroey P, Coddington C, Schwartz L, Gordon K, et al. Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Hum Reprod. 2016;31(9):1997\u0026ndash;2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchirmer DA III, Kulkarni AD, Zhang Y, Kawwass JF, Boulet SL, Kissin DM. Ovarian hyperstimulation syndrome after assisted reproductive technologies: trends, predictors, and pregnancy outcomes. Fertil Steril. 2020;114(3):567\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShmorgun D, Claman P, Gysler M, Hemmings R, Cheung AP, Goodrow GJ, et al. The diagnosis and management of ovarian hyperstimulation syndrome. J Obstet Gynecol Can. 2011;33(11):1156\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res. 2017;151:S61\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H-M, Yao B, Li L, Guo S-S, Deng H-Y, Ren Y-P. Causal relationship between OHSS and immune cells: A Mendelian randomization study. J Reprod Immunol. 2024;165:104314.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEden J, Place J, Carter G, Alaghband-Zadeh J, Pawson M. Is the polycystic ovary a cause of infertility in the ovulatory woman? Clin Endocrinol. 1989;30(1):77\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHomburg R. Polycystic ovary syndrome\u0026mdash;from gynaecological curiosity to multisystem endocrinopathy. Hum Reprod. 1996;11(1):29\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePundir J, Sunkara SK, El-Toukhy T, Khalaf Y. Meta-analysis of GnRH antagonist protocols: do they reduce the risk of OHSS in PCOS? Reproductive biomedicine online. 2012;24(1):6\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeitao VM, Moroni RM, Seko LM, Nastri CO, Martins WP. Cabergoline for the prevention of ovarian hyperstimulation syndrome: systematic review and meta-analysis of randomized controlled trials. Fertil Steril. 2014;101(3):664\u0026ndash;75. e7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalomba S, Costanzi F, Nelson SM, Caserta D, Humaidan P. Interventions to prevent or reduce the incidence and severity of ovarian hyperstimulation syndrome: a systematic umbrella review of the best clinical evidence. Reproductive Biology Endocrinol. 2023;21(1):67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalomba S, Costanzi F, Nelson SM, Besharat A, Caserta D, Humaidan P. Beyond the umbrella: a systematic review of the interventions for the prevention of and reduction in the incidence and severity of ovarian hyperstimulation syndrome in patients who undergo in vitro fertilization treatments. Int J Mol Sci. 2023;24(18):14185.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoares SR, G\u0026oacute;mez R, Sim\u0026oacute;n C, Garc\u0026iacute;a-Velasco JA, Pellicer A. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Update. 2008;14(4):321\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuybrechts KF, Bateman BT, Zhu Y, Straub L, Mogun H, Kim SC, et al. Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol. 2021;224(3):290. e1-. e22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahman RA, Murthi P, Singh H, Gurungsinghe S, Leaw B, Mockler JC, et al. Hydroxychloroquine mitigates the production of 8-isoprostane and improves vascular dysfunction: implications for treating preeclampsia. Int J Mol Sci. 2020;21(7):2504.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbd Rahman R, DeKoninck P, Murthi P, Wallace EM. Treatment of preeclampsia with hydroxychloroquine: a review. J Maternal-Fetal Neonatal Med. 2018;31(4):525\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorigoe M, Sakata K, Ishii A, Iwata S, Nakayamada S, Tanaka Y. Hydroxychloroquine efficiently suppresses inflammatory responses of human class-switched memory B cells via Toll-like receptor 9 inhibition. Clin Immunol. 2018;195:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukla AM, Bose C, Karaduta OK, Apostolov EO, Kaushal GP, Fahmi T, et al. Impact of hydroxychloroquine on atherosclerosis and vascular stiffness in the presence of chronic kidney disease. PLoS ONE. 2015;10(9):e0139226.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVirdis A, Tani C, Duranti E, Vagnani S, Carli L, K\u0026uuml;hl AA, et al. Early treatment with hydroxychloroquine prevents the development of endothelial dysfunction in a murine model of systemic lupus erythematosus. Arthritis Res therapy. 2015;17:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathur R, Jenkins J, Bansal A. The possible role of the immune system in the aetiopathogenesis of ovarian hyperstimulation syndrome. Hum Reprod (Oxford England). 1997;12(12):2629\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, et al. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res. 2020;13:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbramov Y, Schenker J, Lewin A, Friedler S, Nisman B, Barak V. Endocrinology: plasma inflammatory cytokines correlate to the ovarian hyperstimulation syndrome. Hum Reprod. 1996;11(7):1381\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrvieto R. Controlled ovarian hyperstimulation\u0026mdash;an inflammatory state. J Soc Gynecologic Investigation: JSGI. 2004;11:424\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWakiya R, Ueeda K, Nakashima S, Shimada H, Kameda T, Mansour MMF, et al. Effect of add-on hydroxychloroquine therapy on serum proinflammatory cytokine levels in patients with systemic lupus erythematosus. Sci Rep. 2022;12(1):10175.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRouty JP, Angel J, Patel M, Kanagaratham C, Radzioch D, Kema I, et al. Assessment of chloroquine as a modulator of immune activation to improve CD4 recovery in immune nonresponding HIV-infected patients receiving antiretroviral therapy. HIV Med. 2015;16(1):48\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYacoub S, Cadesky K, Casper RF. Low risk of OHSS with follitropin delta use in women with different polycystic ovary syndrome phenotypes: a retrospective case series. J Ovarian Res. 2021;14:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmassi A, Mettler L, Hedderich J, Jonat W, Deenadayal A, Von Otte S, et al. Cut-off levels of anti-mullerian hormone for the prediction of ovarian response, in vitro fertilization outcome and ovarian hyperstimulation syndrome. Int J Fertility Steril. 2015;9(2):157.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroup REASPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGolan A, Weissman A. A modern classification of OHSS. Reprod Biomed Online. 2009;19(1):28\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJulious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Statistics: J Appl Stat Pharm Ind. 2005;4(4):287\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Aacute;lvarez C, Mart\u0026iacute;-Bonmat\u0026iacute; L, Novella-Maestre E, Sanz R, Gomez R, Fernandez-Sanchez M, et al. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. J Clin Endocrinol Metabolism. 2007;92(8):2931\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia-Velasco JA, Pellicer A. New concepts in the understanding of the ovarian hyperstimulation syndrome. Curr Opin Obstet Gynecol. 2003;15(3):251\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFouda UM, Sayed AM, Elshaer HS, Hammad BEM, Shaban MM, Elsetohy KA, et al. GnRH antagonist rescue protocol combined with cabergoline versus cabergoline alone in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial. J Ovarian Res. 2016;9:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoussef MA, Van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang H, Mourad SM, Wang A, Zhai S-D, Hart RJ. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Reviews. 2021(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilic N, \u0026Ouml;zdemir \u0026Ouml;, Başar HC, Demircan F, Ekmez F, Y\u0026uuml;cel O. Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoingin vitro fertilization/intracytoplasmic sperm injection treatment cycles: a randomized controlled study. Avicenna J Med. 2015;5(04):123\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapaleo E, Doldi N, De Santis L, Marelli G, Marsiglio E, Rofena S, et al. Cabergoline influences ovarian stimulation in hyperprolactinaemic patients with polycystic ovary syndrome. Hum Reprod. 2001;16(11):2263\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorabizadeh A, Vahidroodsari F, Ghorbanpour Z. Comparison of albumin and cabergoline in the prevention of ovarian hyperstimulation syndrome: A clinical trial study. Iran J reproductive Med. 2013;11(10):837.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaghshineh E, Khani B, Mesgari L. The efficiency of gnrh antagonist (cetrotide) in comparison of cabergoline in the prevention and treatment of ovarian hyperstimulation syndrome. J Isfahan Med School. 2021;38(606):982\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFouda UM, Elshaer HS, Youssef GG, Hanafy A, Mehrem WM, Youssef MA, et al. Cabergoline versus calcium infusion in the prevention of ovarian hyperstimulation syndrome: a randomised controlled study. J Obstet Gynaecol. 2022;42(1):122\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhasemnejad-Berenji H, Novin MG, Hajshafiha M, Nazarian H, Hashemi S, Ilkhanizadeh B, et al. Immunomodulatory effects of hydroxychloroquine on Th1/Th2 balance in women with repeated implantation failure. Biomed Pharmacother. 2018;107:1277\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang J, Yang X, Yang J, Li M. Hydroxychloroquine inhibits the differentiation of Th17 cells in systemic lupus erythematosus. J Rhuematol. 2018;45(6):818\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillis R, Seif A, McGwin G Jr, Martinez-Martinez L, Gonz\u0026aacute;lez E, Dang N, et al. Effect of hydroxychloroquine treatment on pro-inflammatory cytokines and disease activity in SLE patients: data from LUMINA (LXXV), a multiethnic US cohort. Lupus. 2012;21(8):830\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCostedoat-Chalumeau N, Amoura Z, Duhaut P, Huong DLT, Sebbough D, Wechsler B, et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty‐three cases compared with a control group. Arthr Rhuem. 2003;48(11):3207\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuchanan N, Toubi E, Khamashta MA, Lima F, Kerslake S, Hughes G. Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases. Ann Rheum Dis. 1996;55(7):486\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheumatism: Official J Am Coll Rheumatol. 2006;54(11):3640\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM, et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol. 2014;66(2):444\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeksac MS, Donmez HG. Impact of hydroxychloroquine on the gestational outcomes of pregnant women with immune system problems that necessitate the use of the drug. J Obstet Gynecol Res. 2021;47(2):570\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchreiber K, Hunt BJ. Managing antiphospholipid syndrome in pregnancy. Thromb Res. 2019;181:S41\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSperber K, Hom C, Chao CP, Shapiro D, Ash J. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol. 2009;7:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadeghpour S, Ghasemnejad Berenji M, Nazarian H, Ghasemnejad T, Nematollahi MH, Abroon S, et al. Effects of treatment with hydroxychloroquine on the modulation of Th17/Treg ratio and pregnancy outcomes in women with recurrent implantation failure: clinical trial. Immunopharmacol Immunotoxicol. 2020;42(6):632\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoini A, Sepidarkish M, Dehpour AR, Rabiei M, Abiri A, Pirjani R. The effect of hydroxychloroquine on pregnancy outcomes in patients with unexplained recurrent pregnancy loss: a placebo-controlled study pilot study. J Obstet Gynaecol. 2022;42(8):3471\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirzaei M, Amirajam S, Moghimi ES, Behzadi S, Rohani A, Zerangian N, et al. The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis. J Med Life. 2023;16(2):189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYe S, Liu Y, Zhao X, Ma Y, Wang Y. Hydroxychloroquine improves pregnancy outcomes of women with positive antinuclear antibody spectrum test results. Front Med. 2023;10:1113127.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Moreuil C, Alavi Z, Pasquier E. Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage. Br J Clin Pharmacol. 2020;86(1):39\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-ovarian-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jovr","sideBox":"Learn more about [Journal of Ovarian Research](http://ovarianresearch.biomedcentral.com)","snPcode":"13048","submissionUrl":"https://submission.nature.com/new-submission/13048/3","title":"Journal of Ovarian Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ovarian Hyperstimulation Syndrome (OHSS), Polycystic Ovary Syndrome (PCOS), Cabergoline, Hydroxychloroquine, Reproductive Techniques, Assisted (ART)","lastPublishedDoi":"10.21203/rs.3.rs-5855263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5855263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study compared the effectiveness of cabergoline and hydroxychloroquine in preventing ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThis double-blind, parallel, and randomized clinical trial was performed from April to June 2024. Forty-two patients with PCOS who were candidates for assisted reproductive techniques were randomized into two groups. The first group received 0.5 mg of cabergoline, and the second group received 400 mg of hydroxychloroquine for 8 days. Then, ultrasounds were conducted on days 3 and 5 after oocyte retrieval to assess for OHSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree and five days after oocyte retrieval, laboratory findings, and clinical outcomes were similar between the cabergoline and hydroxychloroquine groups. Key laboratory parameters, including hemoglobin, hematocrit, sodium, potassium, blood urea nitrogen, and creatinine, did not show significant differences between the groups. On day three, OHSS incidence didn\u0026rsquo;t have a significant difference between the hydroxychloroquine and cabergoline groups, both for the mild (31.58% vs. 42.86%) and moderate (15.79% vs. 9.52%) groups. Mild cases were observed in one of the patients in both groups 5 days after pickup (p\u0026thinsp;=\u0026thinsp;0.942). No patients in the cabergoline group required hospitalization or treatment, compared to one in the hydroxychloroquine group (p\u0026thinsp;=\u0026thinsp;0.127).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe incidence of OHSS was similar between cabergoline and hydroxychloroquine, with no significant differences observed in laboratory parameters or clinical outcomes after oocyte retrieval. However, given the study's sample size, further research is needed before these findings can be generalized to a larger population.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e \u003cp\u003e \u003cspan class=\"ExternalRef\"\u003e \u003cspan class=\"RefSource\"\u003ehttp://www.irct.ir\u003c/span\u003e \u003cspan address=\"http://www.irct.ir\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e \u003c/span\u003e; Registration number: IRCT20240305061171N1; Registration date: 2024 June 29\u003c/p\u003e","manuscriptTitle":"Comparative Study of Cabergoline and Hydroxychloroquine to Prevent Ovarian Hyperstimulation Syndrome (OHSS) in PCOS Patients: A Pilot Randomized Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 06:36:13","doi":"10.21203/rs.3.rs-5855263/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-11T09:36:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-13T14:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121205940694860184057029973753495512062","date":"2025-04-13T14:19:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-12T08:12:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-11T14:43:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Ovarian Research","date":"2025-04-09T19:24:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-ovarian-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jovr","sideBox":"Learn more about [Journal of Ovarian Research](http://ovarianresearch.biomedcentral.com)","snPcode":"13048","submissionUrl":"https://submission.nature.com/new-submission/13048/3","title":"Journal of Ovarian Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52d1256f-c8f6-42a3-92b7-3d810c80619c","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:05:53+00:00","versionOfRecord":{"articleIdentity":"rs-5855263","link":"https://doi.org/10.1186/s13048-025-01702-6","journal":{"identity":"journal-of-ovarian-research","isVorOnly":false,"title":"Journal of Ovarian Research"},"publishedOn":"2025-05-29 15:57:34","publishedOnDateReadable":"May 29th, 2025"},"versionCreatedAt":"2025-04-17 06:36:13","video":"","vorDoi":"10.1186/s13048-025-01702-6","vorDoiUrl":"https://doi.org/10.1186/s13048-025-01702-6","workflowStages":[]},"version":"v1","identity":"rs-5855263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5855263","identity":"rs-5855263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}