Coasting: What is the Cost?

Abstract

The objective of this article is to review the current literature on the value of coasting for the prevention of ovarian hyperstimulation syndrome (OHSS). Coasting is a common procedure that is performed in ovarian stimulation cycles at risk of OHSS. Coasting is done by stopping FSH injections and monitoring E2 daily until it drops below 3000 pg/mL then hCG is given. Depriving granulosa cells of the FSH stimulus results in their apoptosis, thus reducing levels of E2 and vascular endothelial growth factor (VEGF linked to the pathogenesis of OHSS). Meanwhile, the small follicles that are dependent on FSH will undergo atresia, while large follicles will not be affected. Coasting is effective in reducing the OHSS rate, but complete prevention is not possible. Prolonged coasting is associated with a significantly lower pregnancy rate.

Randomized trial of combined cabergoline and coasting in preventing ovarian hyperstimulation syndrome during in vitro fertilization/intracytoplasmic sperm injection cycles

“…Consequently, large follicles will continue growing while smaller ones will arrest. Aboulghar concluded that complete prevention of OHSS via coasting is not possible, although it does reduce its rate, and that coasting for more than 3 days would worsen pregnancy rates …”

“…A review by Aboulghar 13 asserted that coasting should involve stopping follicle-stimulating hormone treatment and following E2 levels until they drop to safe levels before introducing hCG. Apoptosis of granulosa cells is initiated; this reduces E2 and vascular endothelial growth factor levels.…”

“…Aboulghar concluded that complete prevention of OHSS via coasting is not possible, although it does reduce its rate, and that coasting for more than 3 days would worsen pregnancy rates. 13 Many studies 3,4,[14][15][16] have confirmed the benefits of coasting, and that outcomes are highly depended on multiple factors; these factors include when to begin coasting, the duration of coasting, and the level of E2 to trigger at. Coasting for more than 4 days has been associated…”

Agonist and antagonist coast

“…Coasting has been employed in ovulation induction since the 1980s (12). Very soon it was introduced for prevention of OHSS in IVF (13) and it has been the most popular method to prevent OHSS for many years (2,10,14,15).…”