Short coasting of 1 or 2 days by withholding both gonadotropins and gonadotropin-releasing hormone agonist prevents ovarian hyperstimulation syndrome without compromising the outcome

Objective

To evaluate the effect of short coasting, by withdrawing both gonadotropins and gonadotropin-releasing hormone (GnRH) agonist, on the prevention of severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome.

Design

Retrospective study.

Setting

Large urban medical center.

Patient(s)

Forty-four women who had been coasted during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

Intervention(s)

When ≥20 follicles >15 mm with serum estradiol (E₂) level of 4000 pg/mL were detected, both gonadotropins and GnRH agonist were withheld for 1 to 2 days.

Main Outcome Measure(s)

Changes of serum E₂ levels, number of oocytes retrieved, pregnancy rate.

Result(s)

The mean serum E₂ level fell from 7915 pg/mL at the onset of coasting to 3908 pg/mL on the day of human chorionic gonadotropin (hCG) administration. The mean number of oocytes retrieved and fertilization rate were 17.2% and 75.0%, respectively. Eighteen patients became pregnant (43.9%), and the implantation rate was 12.7%. Twenty-eight patients were coasted for 1 day, and 13 were coasted for 2 days. The mean decrease rate of serum E₂ level was 45.3% in 1-day coasting and 26.4% (first day) and 75.3% (second day) in 2-day coasting. The pregnancy outcome was similar between both groups. After coasting, three mild and two severe cases of OHSS occurred.

Conclusion(s)

Coasting for 1 or 2 days can be used successfully to prevent OHSS without compromising IVF cycle outcome.

Key Words: Coasting, withdrawing GnRH agonist, ovarian hyperstimulation syndrome, pregnancy outcome