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Abide Yayla C, Ozkaya E, Beydilli Nacak G, Sanverdi I, Devranoglu B, Bostanci Ergen E, Kilicci C, Kutlu T. High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS. Gynecol Endocrinol 2018; 34:798-803. [PMID: 29658351 DOI: 10.1080/09513590.2018.1460344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.
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Affiliation(s)
- Cigdem Abide Yayla
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Enis Ozkaya
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Gulay Beydilli Nacak
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Ilhan Sanverdi
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Belgin Devranoglu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Evrim Bostanci Ergen
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Cetin Kilicci
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Tayfun Kutlu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
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Madani T, Jahangiri N, Eftekhari-Yazdi P, Ashrafi M, Akhoond M. Is Coasting Valuable in All Patients with Any Cause of Infertility? Oman Med J 2016; 31:404-408. [PMID: 27974954 DOI: 10.5001/omj.2016.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to assess the influence of coasting duration on the number and quality of oocytes and fertilization rate in male factor infertile women and those with polycystic ovary syndrome (PCOS). METHODS In this prospective observational follow-up study, 114 patients undergoing coasting (53 women with male factor infertility and 61 women with PCOS) were evaluated at the Royan Institute Research Center, Iran, between 2010 and 2012. RESULTS The results were analyzed according to the coasting periods of 1-4 days. In normal females, the number of oocytes retrieved was significantly reduced after the second day (p = 0.004). In addition, a statistically significant drop was observed in the number of metaphase II oocytes and fertilization rate after the third day (p = 0.006 and p = 0.006, respectively). No significant differences were observed in the number and quality of oocytes retrieved and fertilization rate with regard to coasting days in PCOS patients. CONCLUSION Coasting with duration of more than three days should be performed with caution in normal females who are at risk of developing ovarian hyperstimulation syndrome.
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Affiliation(s)
- Tahereh Madani
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Nadia Jahangiri
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Poopak Eftekhari-Yazdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mahnaz Ashrafi
- Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Akhoond
- Department of Statistics, Mathematical Sciences and Computer Faculty, Shahid Chamran University of Ahvaz, Ahvaz, Iran
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Herrero L, Pareja S, Aragonés M, Cobo A, Bronet F, Garcia-Velasco JA. Oocyte versus embryo vitrification for delayed embryo transfer: an observational study. Reprod Biomed Online 2014; 29:567-72. [DOI: 10.1016/j.rbmo.2014.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/28/2022]
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Elter K, Ozay TA, Ergin E, Ozörnek MH. Serum Oestradiol Pattern during Coasting is Different in Antagonist Cycles Compared with Long Agonist Cycles in In Vitro Fertilisation. Balkan Med J 2014; 30:406-9. [PMID: 25207149 DOI: 10.5152/balkanmedj.2013.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/19/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND GnRH agonists and antagonists have different mechanism of action, and therefore serum estradiol levels might differ during coasting in IVF. AIMS To compare the change in serum oestradiol levels after withholding the gonadotropins for coasting between long agonist and antagonist cycles. STUDY DESIGN Retrospective study. METHODS Antagonist and long agonist cycles, in which coasting was performed, were analysed in this retrospective analysis. Antagonist cycles (n=50) were compared with long agonist cycles (n=52) with respect to daily serum oestradiol levels following withholding of gonadotropins. RESULTS The pattern of change in serum oestradiol was different between groups; it increased on the first day by 11.2% and decreased thereafter on the second and third days in the agonist group. However, it began to decrease from the first day in the antagonist group. Therefore, peak serum oestradiol levels were significantly higher in the agonist group than in the antagonist group (mean±standard deviation; 5798±1748 vs 5104±1351 pg/mL). The duration of coasting was shorter in the antagonist group compared with that in the agonist group (mean±standard deviation; 2.60±1.40 vs 1.96±0.88 days). CONCLUSION Serum oestradiol pattern during coasting is different in antagonist cycles compared with long agonist cycles in in vitro fertilisation.
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Affiliation(s)
- Koray Elter
- Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Elif Ergin
- Eurofertil Reproductive Health Center, İstanbul, Turkey
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Yumuşak ÖH, Kahyaoğlu S, Özgü Erdinç AS, Yılmaz S, Engin Üstün Y, Yılmaz N. Does the serum E2 level change following coasting treatment strategy to prevent ovarian hyperstimulation syndrome impact cycle outcomes during controlled ovarian hyperstimulation and in vitro fertilization procedure? Turk J Obstet Gynecol 2014; 11:159-164. [PMID: 28913010 PMCID: PMC5558327 DOI: 10.4274/tjod.48751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) remains as a clinical problem for hyperresponder patients during controlled ovarian hyperstimulation and in vitro fertilization (COH-IVF) procedure. Herein, we aimed to evaluate the COH-IVF outcomes in hyperresponder patients managed with coasting treatment strategy for OHSS prevention regarding the establishment of clinical pregnancy as an endpoint of the treatment cycle. MATERIALS AND METHODS The medical records related to the COH-IVF outcome in 119 hyperresponder patients who have exhibited a serum estradiol level greater than or equal to 3000 pg/mL were evaluated. The study was conducted on a total of 119 patients, 98 of whom have been treated by coasting or coasting with GnRH antagonist co-treatment strategies, while the remaining 21 women (control group) have not been managed with coasting treatment. The COH and IVF-ET outcomes in the 119 patients were compared based on the coasting treatment situation. RESULTS Among the women who received coasting treatment, the number of patients demonstrating E2 level decrement and also E2 level decrement rate after coasting were similar between patients with and without clinical pregnancy. Total gonadotropin dose, 2PN number, embryo number, and fertilization rate were significantly higher in the patients with a clinical pregnancy. CONCLUSION The coasting treatment is a clinically useful preventive strategy for OHSS avoidance. GnRH antagonist co-treatment decreases the duration of coasting although any detrimental or ameliorating impact of this effect on pregnancy rates have not been seen. The E2 level decrement or increment following coasting treatment seems not to be related to cycle outcomes.
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Affiliation(s)
- Ömer Hamid Yumuşak
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Serkan Kahyaoğlu
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Ayşe Seval Özgü Erdinç
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
| | - Saynur Yılmaz
- Zübeyde Hanım Women’s Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Yaprak Engin Üstün
- Bozok University Faculty of Medicine, Department of Obstetrics and Gynecology, Yozgat, Turkey
| | - Nafiye Yılmaz
- Zekai Tahir Burak Women’s Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey
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Talebi Chahvar S, Zosmer A, Caragia A, Balestrini S, Sabatini L, Tranquilli AL, Al-Shawaf T. Coasting, embryo development and outcomes of blastocyst transfer: a case–control study. Reprod Biomed Online 2014; 29:231-8. [DOI: 10.1016/j.rbmo.2014.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
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Ata B, Tulandi T. Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hill MJ, Chason RJ, Payson MD, Segars JH, Csokmay JM. GnRH antagonist rescue in high responders at risk for OHSS results in excellent assisted reproduction outcomes. Reprod Biomed Online 2012; 25:284-91. [PMID: 22796230 PMCID: PMC3434231 DOI: 10.1016/j.rbmo.2012.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
Gonadotrophin-releasing hormone (GnRH) antagonist rescue is performed by replacing a GnRH agonist with a GnRH antagonist in patients with rapidly rising serum oestradiol who are at risk of ovarian hyperstimulation syndrome (OHSS) during stimulation. It results in a rapid reduction in serum oestradiol, allowing for the avoidance of cycle cancellation and the continuation of exogenous gonadotrophin administration. A total of 387 patients who underwent GnRH antagonist rescue for ovarian hyperresponse were compared with 271 patients who did not receive GnRH antagonist rescue and had oestradiol concentrations >4000 pg/ml on the day of human chorionic gonadotrophin (HCG) administration. GnRH antagonist rescue decreased the mean oestradiol concentration by 35% on the first day of use. There was no difference in oocyte maturity (82% versus 83%) or fertilization rate (69% versus 67%) between the antagonist rescue and comparison groups, respectively. The percentage of high-grade embryos on day 3 and the blastocyst development rate were also similar between groups. The live-birth rate was 41.9% in the antagonist rescue group and 36.9% in the comparison group. GnRH antagonist rescue enabled cycle completion with high live-birth rates in patients at risk for OHSS. GnRH antagonist was associated with high oocyte quality, blastocyst development and pregnancy. Gonadotrophin-releasing hormone (GnRH) antagonist rescue is a protocol to reduce the risk of ovarian hyperstimulation syndrome (OHSS) in assisted reproduction treatment. Patients who have a hyperresponse to medication during their treatment cycle have their GnRH agonist discontinued and a GnRH antagonist started in its place. This causes a rapid reduction in oestrogen concentrations and allows for the continuation of stimulation medication. We evaluated the effectiveness of this protocol by comparing patients who had GnRH antagonist rescue against high-responding patients who did not receive GnRH antagonist rescue. GnRH antagonist rescue resulted in a 35% reduction in oestrogen concentration and only a 1.5% cycle cancellation rate. There were no differences in oocyte maturity or fertilization between the two groups. There were no differences in the quality of day-3 and day-5 embryos between the two groups. The live birth rate was 41.9% in the antagonist rescue group and 36.9% in the comparison group. GnRH antagonist rescue reduced serum oestradiol concentrations and enabled cycle completion with high live-birth rates in patients at risk for OHSS. GnRH antagonist was associated with high oocyte quality, blastocyst development and pregnancy.
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Affiliation(s)
- Micah J Hill
- Walter Reed National Military Medical Center, Washington, DC, USA.
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Sansone P, Aurilio C, Pace MC, Esposito R, Passavanti MB, Pota V, Pace L, Pezzullo MG, Bulletti C, Palagiano A. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci 2011; 1221:109-18. [DOI: 10.1111/j.1749-6632.2011.05983.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Avoiding the use of human chorionic gonadotropin combined with oocyte vitrification and GnRH agonist triggering versus coasting: a new strategy to avoid ovarian hyperstimulation syndrome. Fertil Steril 2011; 95:1137-40. [DOI: 10.1016/j.fertnstert.2010.09.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/22/2022]
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The effect of duration of coasting and estradiol drop on the outcome of assisted reproduction: 13 years of experience in 1,068 coasted cycles to prevent ovarian hyperstimulation. Fertil Steril 2010; 94:1757-63. [DOI: 10.1016/j.fertnstert.2009.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 09/27/2009] [Accepted: 09/29/2009] [Indexed: 11/22/2022]
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DiLuigi AJ, Engmann L, Schmidt DW, Maier DB, Nulsen JC, Benadiva CA. Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting. Fertil Steril 2010; 94:1111-4. [PMID: 20074722 DOI: 10.1016/j.fertnstert.2009.10.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/12/2009] [Accepted: 10/15/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea J DiLuigi
- The Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA.
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Farhi J, Fisch B, Sapir O, Pinkas H, Ben-Haroush A. Effect of coasting on IVF cycle characteristics and outcome in short vs. long GnRH agonist protocols. Gynecol Endocrinol 2010; 26:187-92. [PMID: 20148740 DOI: 10.3109/09513590903015601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare the results of IVF cycles following coasting in patients treated with long versus short GnRH agonist protocols. METHODS A retrospective comparative study in which all women aged 35 years or less attending the IVF unit from 2000 to 2006 in whom coasting was used in GnRH agonist protocols were included. Data on coasting-related variables and outcome were collected from the files and compared between the short GnRH agonist (n = 78) and long GnRH agonist (n = 181) cycles. RESULTS The short GnRH agonist cycles were characterized by higher E2 levels during coasting and longer duration of coasting than the long GnRH agonist cycles. Although the number of retrieved oocytes was lower following coasting in the short protocol, there was no difference between the groups in fertilization rate, number of high-quality embryos available for transfer, and pregnancy rate. Pregnancy rate in both protocols was negatively correlated to E2 level at initiation of coasting. The overall moderate and severe OHSS rate after coasting was 5.1% in the short-protocol group and 6.0% in the long-protocol group (p = 0.76). CONCLUSIONS The ovarian response curve to coasting is longer in the short than in the long GnRH-agonist protocol, but there is no significant difference in pregnancy or OHSS rates.
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Affiliation(s)
- Jacob Farhi
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa, Israel
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Merviel P, Cabry R, Boulard V, Lourdel E, Oliéric MF, Claeys C, Demailly P, Devaux A, Copin H. Risques de la stimulation ovarienne et du prélèvement ovocytaire. ACTA ACUST UNITED AC 2009; 37:926-33. [DOI: 10.1016/j.gyobfe.2009.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
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Farhi J, Ben-Haroush A, Lande Y, Sapir O, Pinkas H, Fisch B. In vitro fertilization cycle outcome after coasting in gonadotropin-releasing hormone (GnRH) agonist versus GnRH antagonist protocols. Fertil Steril 2009; 91:377-82. [DOI: 10.1016/j.fertnstert.2007.11.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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Ng EHY. Adverse effects of excessive ovarian response on the pregnancy rate of in vitro fertilization treatment. Gynecol Endocrinol 2009; 25:2-7. [PMID: 19165656 DOI: 10.1080/09513590802296237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Atabekoglu C, Sonmezer M, Ozkavukcu S, Isbacar S. Unexpected pregnancy despite extremely decreased estradiol levels during ovarian stimulation. Fertil Steril 2008; 90:2003.e5-9. [PMID: 18687425 DOI: 10.1016/j.fertnstert.2008.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report two patients with ongoing pregnancies despite a dramatically sharp decrease in E(2) levels after coasting. DESIGN Case report. SETTING Reproductive endocrinology and assisted reproduction unit of university hospital. PATIENT(S) One 30-year-old and one 25-year-old woman, both with unexplained infertility, in whom E(2) levels increased up to 6345 and 14,275 pg/mL during ovarian hyperstimulation and decreased by 79.5% and 75.5%, respectively, after coasting. INTERVENTION(S) Two IVF treatments during which coasting was performed after high E(2) levels were observed. IVF cycles were carried out despite abrupt E(2) decrease. MAIN OUTCOME MEASUREMENT(S) Development of ovarian hyperstimulation syndrome (OHSS) or fertilization, cleavage, implantation, and pregnancy rates. RESULT(S) Two embryos (one grade A and one grade B) were transferred into the 30-year-old patient and three embryos (all grade A) were transferred into the 25-year-old patient. Neither woman developed OHSS. Two pregnancies on going at gestational weeks 20 and 14, respectively. CONCLUSION(S) Coasting is practiced to avoid severe complications of ovarian hyperstimulation during IVF cycles and is achieved by withholding gonadotropins. The aim of coasting is to lower E(2) levels to a safer range; however, there has been no consistency with respect to the time of coasting or the safety rates of E(2) decrease. We believe that high rates of E(2) decrease after coasting do not have deleterious effects on implantation.
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Affiliation(s)
- Cem Atabekoglu
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Center for Assisted Reproduction and IVF, Ankara University School of Medicine, Ankara, Turkey
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Moon HS, Joo BS, Moon SE, Lee SK, Kim KS, Koo JS. Short coasting of 1 or 2 days by withholding both gonadotropins and gonadotropin-releasing hormone agonist prevents ovarian hyperstimulation syndrome without compromising the outcome. Fertil Steril 2008; 90:2172-8. [PMID: 18439601 DOI: 10.1016/j.fertnstert.2007.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 10/24/2007] [Accepted: 10/24/2007] [Indexed: 11/17/2022]
Abstract
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 >or=20 follicles >15 mm with serum estradiol (E(2)) 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 E(2) levels, number of oocytes retrieved, pregnancy rate. RESULT(S) The mean serum E(2) 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 E(2) 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.
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Affiliation(s)
- Hwa Sook Moon
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine and Infertility, Good Moonhwa Hospital, Busan, South Korea.
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Lin YH, Seow KM, Hsieh BC, Huang LW, Chen HJ, Huang SC, Chen CY, Chen PH, Hwang JL, Tzeng CR. Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles. J Assist Reprod Genet 2007; 24:331-6. [PMID: 17636445 PMCID: PMC3454942 DOI: 10.1007/s10815-007-9127-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 03/12/2007] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate if the combination of clomiphene citrate, hMG, and cetrorelix (CC/hMG/cetrorelix protocol) can be applied to patients who had excessive response to GnRHa long protocol. METHODS Fifty patients who coasted and failed to conceive in their first cycles stimulated with GnRHa long protocol were stimulated with CC/hMG/cetrorelix protocol. The peak serum estradiol levels, the need of coasting and prolonged coasting (>/=4 days), and the incidences of OHSS were compared. RESULTS The peak estradiol level was significantly lower with CC/hMG/cetrorelix protocol compared to GnRHa long protocol. With CC/hMG/cetrorelix protocol, only four patients (8%) needed coasting and no one coasted >/=4 days. In contrast, in the first cycles, 11 patients (22%) needed coasting >/=4 days. The incidence of moderate OHSS was significantly lower with CC/hMG/cetrorelix protocol. CONCLUSIONS The CC/hMG/cetrorelix protocol is an acceptable alternative protocol for patients who had excessive response to GnRHa long protocol.
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Affiliation(s)
- Yu-Hung Lin
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
| | - Bih-Chwen Hsieh
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Heng-Ju Chen
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
| | - Shih-Chia Huang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
| | - Chih-Yu Chen
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
| | - Pei-Hsin Chen
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
| | - Jiann-Loung Hwang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111 Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Chi-Ruey Tzeng
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
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Nardo LG, Cheema P, Gelbaya TA, Horne G, Fitzgerald CT, Pease EHE, Brison DR, Lieberman BA. The optimal length of 'coasting protocol' in women at risk of ovarian hyperstimulation syndrome undergoing in vitro fertilization. HUM FERTIL 2007; 9:175-80. [PMID: 17008270 DOI: 10.1080/14647270600787575] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication following ovarian stimulation for in vitro fertilization (IVF). Coasting is the practice whereby the gonadotrophins are withheld and the administration of human chorionic gonadotrophin (hCG) is delayed until serum oestradiol (E2) has decreased to what is considered to be a safe level, to prevent the onset of OHSS. This study aimed to assess the length of coasting on the reproductive outcome in women at risk of developing OHSS. Coasting was undertaken when the serum E2 concentrations were > or = 17000 pmol/L but < 21000 pmol/L. Daily E2 measurements were performed and hCG was administered when hormone levels decreased to < 17000 pmol/L. Eighty-one women who had their stimulation cycles coasted were grouped according to the number of coasting days. Severe OHSS occurred in one case, which represented 1.2% of patients who underwent coasting because of an increased risk of developing the syndrome. No difference was found between cycles coasted for 1 - 3 days and cycles coasted for > or = 4 days in terms of oocyte maturity, fertilization and embryo cleavage rates. Women in whom coasting lasted for > or = 4 days had significantly fewer oocytes retrieved (P < 0.05) and decreased implantation rate (P < 0.05) compared to those coasted for 1 - 3 days. Pregnancy rate/embryo transfer and live birth rate did not differ between groups. In conclusion, coasting appears to decrease the risk of OHSS without compromising the IVF cycle pregnancy outcome. Prolonged coasting is, however, associated with reduced implantation rates, perhaps due to the deleterious effects on the endometrium rather than the oocytes.
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Affiliation(s)
- Luciano G Nardo
- Department of Reproductive Medicine, Saint Mary's Hospital, Whitworth Park, Manchester, UK.
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21
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Owj M, Tehrani Nejad ES, Amirchaghmaghi E, Ezabadi Z, Baghestani AR. The effect of withholding gonadotropin (a coasting period) on the outcome of in vitro fertilization cycles. Eur J Obstet Gynecol Reprod Biol 2007; 133:81-5. [PMID: 17229513 DOI: 10.1016/j.ejogrb.2006.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 08/04/2006] [Accepted: 10/14/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of coasting (withdrawing gonadotropin administration) on the cycle outcomes, including total number and quality of oocytes and embryos and pregnancy rate in patients undergoing in vitro fertilization. STUDY DESIGN Sixty-seven patients undergoing coasting were evaluated in a retrospective study at the Royan Institute between May 2002 and June 2003. All patients underwent standard long protocol with gonadotropin-releasing hormone (GnRH) analogue and human menopausal gonadotropin (HMG) and then in vitro fertilization and embryo transfer (IVF-ET). Coasting was considered when the estradiol level was more than 3000 pg/ml and the number of follicles >10 in each ovary. HCG was administered whenever estradiol reached < or =3000 pg/ml and then the (IVF-ET) program was carried out. According to coasting periods, patients were divided into two groups: coasting period < or =3 days and coasting period >3 days. Statistical comparisons were performed using Student's t test and Fisher's exact test. RESULTS There were no significant differences between the two groups with regard to mean age, body mass index (BMI), number of polycystic ovary syndrome (PCOS) patients, number of HMG ampoules and stimulation duration. The total number of retrieved oocytes decreased significantly in patients with more than 3 days of coasting (P=0.04). The number of high quality oocytes also decreased in this group; however, this did not reach significant levels. There were no significant differences between the two groups with regard to fertilization and pregnancy rate. None of the patients developed severe ovarian hyperstimulation syndrome (OHSS). CONCLUSION This study reveals that a long coasting period (>3 days) has a negative effect on the number of oocytes, although the fertilization and pregnancy rates are not affected. Prospective randomized studies with larger sample sizes are needed to compare coasting with other procedures.
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Affiliation(s)
- M Owj
- Endocrinology & Female Infertility Department, Royan Institute, Tehran, Iran.
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22
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Cobo A, Bosch E, Alvarez C, de los Santos MJ, Pellicer A, Remohí J. Effect of a sharp serum oestradiol fall before HCG administration during ovarian stimulation in donors. Reprod Biomed Online 2007; 15:169-74. [PMID: 17697492 DOI: 10.1016/s1472-6483(10)60705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The current study evaluated how a sudden fall in serum oestradiol during ovarian stimulation in donors affects recipient outcome. After the assessment of pregnancy rate in cases of oestradiol falls of <10 or > or =10% (57.0 versus 45.6%), <20 or > or = 20% (55.2 versus 44.9%), <25 or > or =25% (57.2 versus 41.2%), and < 30 or > or =30% (57.1 versus 32.0%; P < 0.05), a significantly lower pregnancy rate was observed when the fall was > or =30%. Therefore, the study group (n = 25) included recipients who received oocytes from donors with a fall of > or =30%, and the control group included patients (n = 197) in which the fall in oestradiol was <30% and all cases with no fall in oestradiol concentrations. Pregnancy rates in both groups were 32.0 versus 57.1%; P < 0.05. The number of morphologically normal oocytes was similar (14.2 versus 18.1%) and good quality embryos was lower (8.0 versus 21.0%; P < 0.05) for study group. This seems related to a lower capability of the embryos to implant (15.2 versus 37.4%; P < 0.001). These data indicate that a fall of > or =30% in serum oestradiol concentration during ovarian stimulation in donors negatively affects pregnancy rates and embryo quality in recipients. In these cases, cycle cancellation should be considered.
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Affiliation(s)
- Ana Cobo
- Instituto Valenciano de Infertilidad, Plaza de la Policía Local 3. 46015 Valencia, Spain
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Aboulghar MA, Mansour RT, Amin YM, Al-Inany HG, Aboulghar MM, Serour GI. A prospective randomized study comparing coasting with GnRH antagonist administration in patients at risk for severe OHSS. Reprod Biomed Online 2007; 15:271-9. [PMID: 17854523 DOI: 10.1016/s1472-6483(10)60339-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This work evaluated possible advantages of gonadotrophin-releasing hormone (GnRH) antagonist administration as an alternative to coasting in prevention of severe ovarian hyperstimulation syndrome (OHSS) in women undergoing IVF/ intracytoplasmic sperm injection. A prospective randomized study comparing coasting (group A) (n = 96) and GnRH antagonist administration (group B) (n = 94) in patients at risk of OHSS was performed. The primary outcome measure was high quality embryos. The secondary outcome measures were days of intervention, number of oocytes, pregnancy rate, number of cryopreserved embryos and incidence of severe OHSS. There were significantly more high quality embryos (2.87 +/- 1.2 versus 2.21 +/- 1.1; P < 0.0001), and more oocytes (16.5 +/- 7.6 versus 14.06 +/- 5.2; P = 0.02), in group B as compared with group A. There were more days of coasting as compared with days of antagonist administration (2.82 +/- 0.97 versus 1.74 +/- 0.91; P < 0.0001). In conclusion, GnRH antagonist was superior to coasting in producing significantly more high quality embryos and more oocytes as well as reducing the time until HCG administration. There was no significant difference in pregnancy rate between the two groups. No OHSS developed in either group.
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Affiliation(s)
- Mohamed A Aboulghar
- The Egyptian IVF-ET Centre, 3 St 161, Hadaek El Maadi, Maadi, Cairo 1143, Egypt.
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Gustofson RL, Segars JH, Larsen FW. Ganirelix acetate causes a rapid reduction in estradiol levels without adversely affecting oocyte maturation in women pretreated with leuprolide acetate who are at risk of ovarian hyperstimulation syndrome*. Hum Reprod 2006; 21:2830-7. [PMID: 16966348 DOI: 10.1093/humrep/del059] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated estradiol (E(2)) levels predispose to development of ovarian hyperstimulation syndrome (OHSS). Since GnRH antagonist is associated with a reduction in E(2) levels, we hypothesized that GnRH-antagonist treatment of women down-regulated with GnRH agonist who are at risk of OHSS might reduce E(2) levels and avoid cycle cancellation. METHODS Retrospective study in a university-based assisted reproduction technology (ART) programme in 87 patients treated with long luteal (LL) or microdose flare (MDF) with ovarian hyperresponse and 87 control patients without ovarian hyperresponse. GnRH-antagonist (ganirelix acetate) treatment was started and leuprolide acetate discontinued in women who failed to respond to a reduction in gonadotrophin dosage. RESULTS In the treatment group, there was a significant, reproducible reduction in serum E(2) levels. Mean E(2) at the start of ganirelix treatment was 4219.8 pg/ml and decreased in 24 h to 2613.7 pg/ml (36.7%; P < 0.001). An average of 24.9 +/- 8.8 oocytes were obtained at retrieval and an average of 19.1 +/- 8.0 were metaphase II (79.2%). Fertilization occurred in 13.9 +/- 8.1 embryos (72.8%). In this high risk group, two cases of severe OHSS (2.3%) occurred. The ongoing pregnancy rate was 51.8%. Compared with the control group, there were no statistically significant differences in the rate of oocyte recovery, oocyte maturity, 2PN rate, fertilization, cancellation, OHSS or pregnancy. CONCLUSIONS GnRH-antagonist treatment of women pretreated with GnRH agonist rapidly reduced circulating serum E(2) without adversely affecting oocyte maturation, fertilization rates or embryo quality and resulted in a high pregnancy rate in this subgroup of patients at risk of OHSS.
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Rosen MP, Shen S, Dobson AT, Fujimoto VY, McCulloch CE, Cedars MI. Triploidy formation after intracytoplasmic sperm injection may be a surrogate marker for implantation. Fertil Steril 2006; 85:384-90. [PMID: 16595215 DOI: 10.1016/j.fertnstert.2005.07.1321] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Revised: 07/27/2005] [Accepted: 07/27/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Triploidy after intracytoplasmic sperm injection (ICSI) is due mostly to retention of the second polar body. Our interest was to determine the predictors of triploidy and to determine whether the presence of triploidy can serve as a surrogate marker of implantation for the remaining cohort of zygotes. DESIGN Cohort study. SETTING Academic research center. PATIENT(S) Infertile couples undergoing IVF/ICSI. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Triploid zygote (3PN) rate, implantation rate. RESULT(S) The 3PN rate is a significant predictor of implantation rate for the remaining cohort of zygotes. The starting and total dose of gonadotropins administered and the total days of stimulation are independent predictors of the 3PN rate. CONCLUSION(S) In couples with a normal semen analysis undergoing IVF/ICSI, the 3PN rate may serve as a surrogate marker of oocyte quality and may be altered by adjusting the stimulation protocol.
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Affiliation(s)
- Mitchell P Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
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26
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García-Velasco JA, Isaza V, Quea G, Pellicer A. Coasting for the prevention of ovarian hyperstimulation syndrome: much ado about nothing? Fertil Steril 2006; 85:547-54. [PMID: 16500317 DOI: 10.1016/j.fertnstert.2005.07.1335] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 07/07/2005] [Accepted: 07/07/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review and critique the literature and our own experience regarding coasting as a strategy to prevent ovarian hyperstimulation syndrome (OHSS). DESIGN Identification of relevant clinical literature through PubMed and EMBASE databases, as well as the experience of our institution with this approach. CONCLUSION(S) Coasting is a rescue procedure that can be avoided by carefully adjusting the gonadotropin dosage. It is a good alternative that can be used to avoid cycle cancellation in extremely high responders to controlled ovarian hyperstimulation, who have a high risk of developing severe OHSS. Even if OHSS develops after coasting, both its incidence and severity will be diminished. Each case should be individually counseled to determine whether the patient should be coasted, and her hypothetical risks and benefits should be evaluated. Until the multifactorial etiopathogenesis of OHSS is completely understood, absolute prevention will not be possible, but coasting is definitely of great benefit.
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27
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Arslan M, Bocca S, Jones E, Mayer J, Stadtmauer L, Oehninger S. Effect of coasting on the implantation potential of embryos transferred after cryopreservation and thawing. Fertil Steril 2006; 84:867-74. [PMID: 16213837 DOI: 10.1016/j.fertnstert.2005.03.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Revised: 03/31/2005] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the effect of withholding gonadotropins on the outcome of embryos after cryopreservation and thawing. DESIGN Retrospective clinical evaluation of patients having cryopreserved-thawed ET trials with coasting during the corresponding ovarian stimulation cycle. SETTING Academic tertiary clinical care unit. PATIENT(S) Patients with cryopreserved embryos having coasting in their fresh IVF cycle and age-matched controls without coasting, both groups receiving the same stimulation protocol (long GnRH agonist plus recombinant FSH). INTERVENTION(S) All patients had a cycle in which embryos were transferred fresh and a cycle of thawing of cryopreserved embryos with the aim of transferring in a steroid-supplemented cycle. MAIN OUTCOME MEASURE(S) Embryo survival, implantation, and clinical pregnancy rates. RESULT(S) Post-thawing embryo survival (66.4% vs. 73%), implantation (12.3% vs. 13.0%), and clinical pregnancy rates (31.5% vs. 38.0%) were similar in study and control groups, respectively. Patients with coasting for > or =3 days had significantly lower post-thawing embryo survival rates compared with patients having shorter duration of coasting (<3 days) and controls. Implantation and pregnancy rates, however, were similar in the three groups. CONCLUSION(S) Coasting did not seem to have a detrimental effect on oocyte and embryo quality because the implantation competence of transferred concept after cryopreservation and thawing was similar to that of controls. However, prolonged coasting (> or =3 days) had a subtle negative impact on the post-thaw survival rate.
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Affiliation(s)
- Murat Arslan
- Department of Obstetrics and Gynecology, The Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
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28
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Gustofson RL, Larsen FW, Bush MR, Segars JH. Treatment with gonadotropin-releasing hormone (GnRH) antagonists in women suppressed with GnRH agonist may avoid cycle cancellation in patients at risk for ovarian hyperstimulation syndrome. Fertil Steril 2006; 85:251-4. [PMID: 16412770 DOI: 10.1016/j.fertnstert.2005.07.1291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 06/05/2005] [Accepted: 06/05/2005] [Indexed: 10/25/2022]
Abstract
Forty-seven patients at high risk for ovarian hyperstimulation syndrome because of markedly elevated serum E2 levels on either long-luteal or microdose flare leuprolide acetate regimens were treated with ganirelix acetate. Despite being pretreated with GnRH agonist and without withholding gonadotropins, serum E2 decreased by 49.5% and 41.0% of pretreatment values (long luteal and microdose flare, respectively) after initiation of ganirelix, and 68.1% of the patients became pregnant.
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Affiliation(s)
- Robert L Gustofson
- Walter Reed Army Medical Center, National Naval Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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29
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Zhu WJ, Li XM, Chen XM, Zhang L. Follicular aspiration during the selection phase prevents severe ovarian hyperstimulation in patients with polycystic ovary syndrome who are undergoing in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2005; 122:79-84. [PMID: 16154042 DOI: 10.1016/j.ejogrb.2005.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Revised: 12/06/2004] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective was to assess the effectiveness of follicular aspiration in the selection phase of infertile women with polycystic ovary syndrome (PCOS) under controlled ovarian hyperstimulation (COH). STUDY DESIGN In group A, 13 infertile patients with PCOS failed at previous IVF or intracytoplasmic sperm injection (ICSI) treatment due to ovarian hyperstimulation syndrome (OHSS; a total of 13 cycles). In group B, new IVF cycles with ultrasound-guided transvaginal follicular aspirations during the selection phase (a total of 13 cycles) were conducted using the same patients. No more than ten follicles remained in bilateral ovaries. Parameters monitored included ovarian size, number of dominant follicles, estradiol (E2) level on the day of human chorionic gonadotrophin (HCG) injection, maturation of oocytes, fertilization rate, cleavage rate, embryo implantation rate, pregnancy rate, and level of serum hormone. RESULTS In group B, the average number of follicles>or=12 mm and average serum E2 level were 15.5+/-4.0 and 9899+/-1430 pmol/l, respectively, which were significantly lower than 29.1+/-8.4 (P<0.001) and 15,544+/-1766 pmol/l (P<0.001) in group A. No cycles with moderate or severe OHSS occurred in group B, while nine out of 13 (69.2%) cycles did have this problem in group A. Oocyte maturation rate, fertilization rate and cleavage rate in group B were 80.7%, 76.9%, and 80.3%, respectively; and all of them are significantly higher than 56.4% (P<0.01), 58.7% (P<0.01), and 70.2% (P<0.02) respectively in group A. CONCLUSION Follicular aspiration during the selection phase can prevent severe OHSS and reduce OHSS prevalence in patients with PCOS undergoing COH.
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Affiliation(s)
- Wen-Jie Zhu
- Department of Reproductive Health, ShenZhen City Maternity and Child Healthcare Hospital, No. 2004, Hongli Road, ShenZhen 518028, Guangdong Province, China.
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Merviel P, Claeys C, Héraud MH, Lourdel E, Lanta S, Barbier F, Nasreddine A. [Coasting and ovarian stimulation protocols in high-responder patients undergoing assisted conception]. ACTA ACUST UNITED AC 2005; 33:703-12. [PMID: 16129645 DOI: 10.1016/j.gyobfe.2005.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 06/24/2005] [Indexed: 10/25/2022]
Abstract
Over-responsive patients are at risk of ovarian hyperstimulation, which may lead to severe complications. The choice of ovarian stimulation protocol or the use of a coasting (gonadotrophins suspension) with its associated risk of too strong ovarian response will be discussed herein. As for in vitro fertilization stimulation protocols, the best are probably those which use steadily increasing low doses of gonadotrophins, associated to GnRH agonists (low-dose protocols) or those which complete a double hypophyseal inhibition (estro-progestative association and GnRH agonists). GnRH antagonists may also reduce the risk of ovarian hyperstimulation, by estradiol drop. Outside the context of in vitro fertilization GnRH continuous administration or low -dose gonadotrophin stimulation are the best options. A coasting will be performed when an excess follicle response is documented. Under strict hormonal follow-up and within four days it allows achieving a high rate of pregnancy with a lower risk of hyperstimulation. Compared to other therapies of hyperstimulation syndrome, the coasting allows to avoid cycle cancellation or freezing of all embryos.
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Affiliation(s)
- P Merviel
- Centre d'assistance médicale à la procréation, CHU d'Amiens, 124, rue Camille-Desmoulins, 80054 Amiens cedex 01, France.
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Mansour R, Aboulghar M, Serour G, Amin Y, Abou-Setta AM. Criteria of a successful coasting protocol for the prevention of severe ovarian hyperstimulation syndrome. Hum Reprod 2005; 20:3167-72. [PMID: 16006465 DOI: 10.1093/humrep/dei180] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to report a large series of patients (n = 1223) at risk of developing ovarian hyperstimulation syndrome (OHSS) who underwent coasting. METHODS Coasting started when the leading follicle reached 16 mm and continued until the estradiol (E2) level fell to 3000 pg/ml. RESULTS The E2 level at the start of coasting was (mean +/ SD) 6408 +/- 446 and it fell to 2755 +/- 650 on the day of HCG injection, after (mean +/- SD) 2.89 +/- 0.94 days. The results were analysed according to the duration of coasting (< or = 3 days, group I: n = 983; >3 days, group II: n = 240). The number of oocytes retrieved was (mean SD) 16.45 +/- 6.25 and 14.93 +/- 6.01 in groups I and II respectively (P < 0.05). The fertilization rates were 63 and 65% in groups I and II respectively (P > 0.05). The implantation and clinical pregnancy rates were 26 and 52% in group I compared to 18 and 36% in group II respectively (P < 0.05). Severe OHSS occurred in 16 cases, which represented 0.13% of all stimulated cycles, and 1.3% of patients who were at risk of developing OHSS. CONCLUSIONS Our protocol of coasting was an effective measure in the prevention of OHSS, without jeopardizing the ICSI outcome. Coasting for >3 days is associated with a moderate decrease in the pregnancy rate.
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Affiliation(s)
- Ragaa Mansour
- The Egyptian IVF-ET Center, 3, Road 161 Hadayek El-Maadi, Cairo 11431, Egypt.
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32
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Garcia-Velasco JA, Pellicer A. Reply: coasting acts through down regulation of VEGF gene expression and protein secretion. Hum Reprod 2005. [DOI: 10.1093/humrep/deh629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ulug U, Ben-Shlomo I, Bahceci M. Predictors of success during the coasting period in high-responder patients undergoing controlled ovarian stimulation for assisted conception. Fertil Steril 2004; 82:338-42. [PMID: 15302281 DOI: 10.1016/j.fertnstert.2003.12.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Revised: 12/11/2003] [Accepted: 12/11/2003] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prognostic factors analyzed during the coasting period that can be used to predict outcomes of IVF cycles. DESIGN Retrospective review of data from a single center. SETTING Referral private IVF center. PATIENT(S) Three hundred forty-six patients who were coasted for the prevention of ovarian hyperstimulation syndrome (OHSS) and 262 patients who were not coasted but having excessive E(2) levels during controlled ovarian hyperstimulation for assisted conception. INTERVENTION(S) Controlled ovarian hyperstimulation, oocyte retrieval, intracytoplasmic sperm injection, and embryo transfer. MAIN OUTCOME MEASURE(S) Number of total oocytes retrieved, oocyte maturity, fertilization, implantation and pregnancy rates (IR and PR, respectively), and incidence of severe OHSS. RESULT(S) No difference was found between early onset coasted patients, late onset coasted patients, and uncoasted patients in terms of fertilization rates, IR, PR, and incidence of severe OHSS. Fertilization and PR did not correlate significantly with decreases in E(2) level during the coasting period. Implantation rates and PR in patients who were coasted > or =4 days were significantly reduced compared with patients who were coasted for 1-3 days. In logistic regression model, the decrease in PR with prolonged coasting was found to be significant; however, there was no correlation between decreased PR and the decrease in E(2) levels during the coasting period. CONCLUSION(S) Coasting can be applied safely to controlled hyperstimulation cycles without compromising the outcome. The duration of coasting seems to be a prognostic factor for the outcome of IVF. The criteria for initiation of coasting should be based on clinical experience and assessment of the patient.
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Affiliation(s)
- Ulun Ulug
- Bahceci Women Health Care Center and German Hospital at Istanbul, Nisantasi, 80200 Istanbul, Turkey
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Balasch J, Fábregues F, Peñarrubia J, Creus M, Manau D, Vidal E, Casamitjana R, Vanrell JA. Outcome from consecutive assisted reproduction cycles in patients treated with recombinant follitropin alfa filled-by-bioassay and those treated with recombinant follitropin alfa filled-by-mass. Reprod Biomed Online 2004; 8:408-13. [PMID: 15149563 DOI: 10.1016/s1472-6483(10)60924-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recent advances in manufacturing procedures for r-hFSH have resulted in a preparation (follitropin alfa) that is highly consistent in both isoform profile and glycan species distribution. As a result, follitropin alfa can be reliably quantified and vials can be filled by mass. This study compared the clinical results in a well-established assisted reproduction programme during the crossover from standard follitropin alfa filled-by-bioassay (FSH-bio) to follitropin alfa filled-by-mass (FSH-mass). The study included the last 125 patients treated with FSH-bio and the first 125 patients receiving FSH-mass for ovarian stimulation in their first assisted reproduction treatment cycle. Patient baseline characteristics were almost identical in the two groups. The duration of ovarian stimulation was significantly shorter in the FSH-mass group. The number of patients receiving the HCG injection and undergoing oocyte retrieval, follicular development and the serum concentration of oestradiol on the day of HCG injection were similar for the two treatment groups. The oocyte yield and the fertilization rates were similar in both groups of patients. However, embryo quality and implantation rates were significantly higher in the FSH-mass group. Accordingly, in spite of the mean number of embryos transferred being significantly lower in the FSH-mass group, there was a trend for higher clinical pregnancy rates in this group of patients. It is concluded that the new formulation of FSH-mass is more effective than the standard FSH-bio in terms of embryo quality, implantation rates, and number of days of stimulation.
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Affiliation(s)
- Juan Balasch
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Moreno L, Diaz I, Pacheco A, Zúñiga A, Requena A, Garcia-Velasco JA. Extended coasting duration exerts a negative impact on IVF cycle outcome due to premature luteinization. Reprod Biomed Online 2004; 9:500-4. [PMID: 15588466 DOI: 10.1016/s1472-6483(10)61633-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coasting, or withholding gonadotrophin administration while maintaining gonadotrophin-releasing hormone analogue until oestradiol drops to a safe concentration, is an alternative approach to prevent ovarian hyperstimulation syndrome (OHSS) in high responder patients. However, the length of this procedure has not been precisely studied. This paper is a retrospective study of 132 patients who showed a high response (oestradiol > 4500 pg/ml and/or more than 20 follicles > 17 mm) to ovarian stimulation and were coasted due to their high risk of developing OHSS, and evaluated the impact of the duration of coasting on IVF cycle outcome. Additionally, serum LH and progesterone concentrations were studied to investigate whether premature luteinization was present in these cycles and whether it might be related to coasting duration. A significant decrease in implantation rate was found when coasting was required for more than 4 days, together with a trend towards a higher cancellation rate. Premature luteinization was significantly elevated in women undergoing coasting compared with control women (34 versus 15.6%, P < 0.05). In the majority of patients who showed premature luteinization, coasting lasted >/=3 days. To conclude, prolonged coasting may affect the endometrium, anticipating the implantation window. These data may explain why some women undergoing extended coasting show a lower implantation rate compared with controls.
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Affiliation(s)
- L Moreno
- IVI-Madrid, Rey Juan Carlos University, Madrid, Spain
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