‘Prolonged coasting’: an effective method for preventing severe ovarian hyperstimulation syndrome in patients undergoing in-vitro fertilization

Abstract

Over a 4 year period ending 1 January 1995, 51 women scheduled for in-vitro fertilization (IVF) and embryo transfer were inadvertently severely overstimulated with menotrophins, as evidenced by the development of > 29 ovarian follicles in association with peak plasma oestradiol concentrations of > 6000 pg/ml. Accordingly, these women were at great risk of developing life-endangering complications associated with severe ovarian hyperstimulation syndrome (OHSS). Treatment involved withholding the administration of both menotrophins and human chorionic gonadotrophin for a number of days, while continuing gonadotrophin-releasing hormone agonist until the plasma oestradiol concentration fell to < 3000 pg/ml ('prolonged coasting'). The mean number of oocytes retrieved was 21.0, while the mean number of embryos transferred per procedure was 5.4. There were 21 clinical pregnancies (i.e. pregnancy rate of 41% per oocyte retrieval), 19 of which resulted in live births (i.e. a live birth rate of 37% per oocyte retrieval). Two pregnancies miscarried and there were four multiple gestations (three sets of twins and one set of triplets). None of the women developed severe OHSS. Prolonged coasting is an effective method of preventing the occurrence of severe OHSS without necessitating the cancellation of the IVF cycle or compromising success rates.

Pronuclear embryo cryopreservation experience: outcomes for reducing the risk of ovarian hyperstimulation syndrome and for fertility preservation in cancer patients

“…Several strategies have been attempted to prevent OHSS including cycle cancellation [6], coasting [7,8], altering the Capsule Pronuclear embryo freezing with delayed embryo transfer for patients at risk of ovarian hyperstimulation and cancer patients is effective for achieving pregnancy.…”

Features of the renin-angiotensin system in ascites and pleural effusion during severe ovarian hyperstimulation syndrome

“…The serum E2 levels reached 4800 pg/ml. To avoid canceling the cycle, and to prevent as much as possible the development of OHSS, the "prolonged coasting" method (8) was applied to the stimulation protocol by stopping the gonadotropin therapy for 2 days, while continuing the administration of buserelin. Ovulation induction was performed using 10,000 IU hCG when serum Ez levels had fallen to 3200 pg/ml.…”

Aromatase Inhibitors Versus Cabergoline for the Prevention of Ovarian Hyperstimulation Syndrome: a Prospective, Randomized, Double-Blind Study

“…Though the role of elevated E2 in OHSS has not been confirmed, estradiol concentrations on the day of hCG administration seem to play a role in OHSS development 29 and lowering E2 level helps to prevent OHSS 30 . One way to decrease estradiol is aromatase inhibitors and so this could be used to prevent OHSS when used in the early luteal phase by acting on the sustained corpora lutea.…”