Effect of coasting on cycle outcome during in vitro fertilization/intracytoplasmic sperm injection cycles in hyper-responders

Dopamine agonist bromocriptine for the prevention of ovarian hyperstimulation syndrome

“…Furthermore, even if E 2 levels may fall with coasting, E 2 is not directly involved in the pathophysiologic origin of OHSS (5). In addition, two of four patients with moderate OHSS symptoms and two of the three patients who were hospitalized were also coasted, two facts that corroborate the findings of Kov acs et al (14) and Humaidan et al (15). In our collective, none of the patients experienced a late-onset OHSS, which is defined by Lyons et al (11) as occurring not later than 17 days after hCG administration.…”

“…Methodologically, not all patients were treated in the same manner, with some patients being coasted or receiving NaCl or glucose infusions. From literature, coasting or fluid infusions seems not to reduce OHSS symptoms (14)(15)(16). Furthermore, even if E 2 levels may fall with coasting, E 2 is not directly involved in the pathophysiologic origin of OHSS (5).…”

“…Arguments for the use of bromocriptine in patients at risk for OHSS are its shorter half-life and greater experience with the drug in pregnancy (12,14). In addition, cabergoline was removed from the U.S. market in 2007 after a pair of studies implicated this dopamine agonist in causing serious heart valve damage.…”

Reply of the Authors

“…Admittedly, a limiting factor of our study is the additional use of other treatments, such as coasting and infusion therapy with NaCl or glucose in a subset of patients. However, coasting or fluid infusions do not seem to reduce the incidence of OHSS (1,7,8). Notably, in our study, 50% of patients at high risk did not develop OHSS.…”

Agonist and antagonist coast

“…In a retrospective study (19) the average length of coasting in GnRH agonist cycles was 2.2 days. A significant decrease in implantation rate was reported when coasting lasted for 4 or more days, together with a trend towards a higher cancellation rate (20).…”