Introduction: The ovarian hyperstimualation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART) especially in patients with polycystic ovarian syndrome (PCOS). Ketoconazole (K) is an antimyeotic drug and P450 hydroxylase inhibitor with short half-life which has been sued to reduce hyperandrogenism and to attenuate the ovarian response during induction of ovulation in PCOS patients. In this study, the clinical efficacy of K on ovarian steroidogenesis was investigated during ART in PCOS patients.
Material and Methods: A total of 88 PCOS patients, less than 36 years old were enrolled for IVF or IVF or ICSI, in all of whom OHSS either occurred or there was the risk of occurrence in a previous ART cycle. They were included in a prospective randomized clinical trial study. Long protocol with buserelin and gonadotropin were used in all of them. 30 cases did not received K (group I). 30 cases received K (50mg every 48 hours starting 4th day of stimulation (group II). And 28 cases received K with the same dose daily (group III). Serum E2, lead follicules, retrieved oocytes, fertilization rate, development of OHSS and cancellation rate were compared between the group using non paired t-test, ?2 and fisher’s exact test.
Results: There were on significant differences between the groups in total number of HMG ampules, stimulation days number of filicles³16 and peak of E2 on HCG day.
The number of cancelled cycles was 2/30 in group I, II and 1/28 in group III (not significant). There were no significant differences in number and maturity of retrieved oocytes and fertilization rate between the groups.
Conclusion: This study revealed low dose of K can not significantly reduce ovarian response and OHSS during ART cycles. It may be related to higher stimulation in ART compared to induction. However, K has no effect on the number and maturity of oocyte and fertilization rate.
Whether earlier and more intense administration of K reduces OHSS during ART remains to be evaluated in future studies.