Clinical and endocrine response to the withdrawal of gonadotropin-releasing hormone agonists during prolonged coasting

Yuen, Basil Ho; Nguyen, Tuan-Anh T.; Cheung, Anthony P.; Leung, Peter C.K.

doi:10.1016/j.fertnstert.2008.06.039

Cited by 6 publications

(5 citation statements)

References 31 publications

(34 reference statements)

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“…The negative correlation of serum FSH level on the hCG day to the BMI and pretreatment basal FSH is difficult to explain but may be associated with factors like absorption, body fat distribution, and clearance [32]. The negative correlation of serum FSH on the hCG day on the duration of coasting is in agreement with other studies [22, 28, 33].…”

Section: Discussionsupporting

confidence: 84%

Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Vitthala

Bouaziz²,

Zosmer³

et al. 2012

International Journal of Endocrinology

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Introduction. Coasting is the most commonly used strategy in prevention of severe OHSS. Serum FSH levels measurements during coasting may aid in optimizing the duration of coasting. Objective(s). To study live birth rates (LBRs), clinical pregnancy rates (CPRs), and optimal duration of coasting based on serum FSH levels on the hCG day. Materials and Methods. It is a retrospective study performed between 2005 and 2008 at Barts and The London Centre for Reproductive Medicine, NHS Trust, London, UK, on 349-coasted women undergoing controlled ovarian stimulation (COS) for IVF ± ICSI. The serum FSH level measurements on the hCG day during coasting programme were analysed to predict the LBR and CPR. Result(s). LBR and CPR were significantly higher when the FSH levels on the hCG day were >2.5 IU/L (LBR: 32.5%, P = 0.045 and CPR: 36.9%, P = 0.027) compared to FSH <2.5 IU/L. The optimal FSH cut-off level for LBR and CPR is 5.6 IU/L on the hCG day. The optimal cutoff for coasting is 4 days. Conclusion(s). Coasting may be continued as long as either serum FSH level is > 2.5 IU/L on the hCG day without compromising the LBR and CPR or to maximum of 4 days.

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Section: Discussionsupporting

confidence: 84%

Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Vitthala

Bouaziz²,

Zosmer³

et al. 2012

International Journal of Endocrinology

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“…For example, Ho Yuen et al discontinued GnRHa during coasting [122]. This was followed by a 60% decrease in mean E2 levels within 24 h, enabling hCG injection.…”

Section: Coastingmentioning

confidence: 99%

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Ata

Tulandi²

2009

Expert Review of Obstetrics & Gynecology

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Ovarian hyperstimulation syndrome (OHSS) is characterized by ovarian enlargement, ascites and pleural effusion. Most cases of OHSS develop after ovarian stimulation with gonadotropins. The basis of the process is increased vascular permeability, and this is related to VEGF. VEGF is produced in granulosa cells in response to gonadotropin stimulation and its secretion is augmented following human chorionic gonadotropin administration. One of the major risk factors is polycystic ovaries. Preventive strategies include mild stimulation protocols, coasting, in vitro maturation, infusion of macromolecule solutions and coadministration of dopamine agonists. OHSS is a self-limiting condition and most cases can be managed with paracentesis and fluid replacement. In this article, we review pathogenesis, risk factors, strategies for prevention and management of OHSS. Keywords: albumin • cabergoline • coasting • dextran • dopamine • hydroxyethylstarch • macromolecule • ovarian hyperstimulation syndrome • pathogenesis • prevention • treatment • VEGF Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment Expert Rev.

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“…Two centres for IVF recently reported that the withdrawal of GnRH agonist during the coasting period sharply decreased oestradiol concentration within 1-2 days following the withdrawal, which helped to prevent both cycle cancellation and ovarian hyperstimulation syndrome (OHSS) (Moon et al, 2008;Ho Yuen et al, 2009). However, the role of GnRH agonist withdrawal and the underlying mechanisms for the effects of the withdrawal are unknown; this is because both GnRH agonist and gonadotrophins were simultaneously withdrawn in the above-mentioned studies.…”

Section: Introductionmentioning

confidence: 99%

Withdrawal of GnRH agonist decreases oestradiol and VEGF concentrations in high responders

Ding¹,

Wang²,

Shen

et al. 2013

Reproductive BioMedicine Online

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This study evaluated whether the withdrawal of a gonadotrophin-releasing hormone (GnRH) agonist before triggering ovulation reduces the incidence of ovarian hyperstimulation syndrome (OHSS) in high-risk infertility patients who were treated with gonadotrophins. GnRH agonist was withdrawn for 2 or 3 days when dominant follicles were ≥14 mm in diameter, according to the GnRH agonist long protocol. Non-withdrawal of GnRH agonist was used as control. The serum concentration of oestradiol on the ovulation trigger day was significantly decreased in the GnRH agonist withdrawal group compared with the control group (5750.78 ± 2344.77 pg/ml versus 8076.43 ± 1981.67 pg/ml); however, the number of retrieved oocytes and the fertilization rate were similar between the groups. In addition, the concentrations of vascular endothelial growth factor in plasma on day of human chorionic gonadotrophin administration and follicular fluid on the oocyte retrieval day were decreased following GnRH agonist withdrawal. In fresh embryo transfer cycles, rates of clinical pregnancy, implantation and OHSS were not different between the groups. When GnRH agonist withdrawal was followed by total embryos cryopreserved, the rate of OHSS was decreased compared with the control group (0% versus 8.70%). Clinical pregnancy rates in cryopreserved embryo transfer cycles were comparable between the two groups.

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Clinical and endocrine response to the withdrawal of gonadotropin-releasing hormone agonists during prolonged coasting

Cited by 6 publications

References 31 publications

Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Serum FSH Levels in Coasting Programmes on the hCG Day and Their Clinical Outcomes in IVF ± ICSI Cycles

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Withdrawal of GnRH agonist decreases oestradiol and VEGF concentrations in high responders

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