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

Abdalla, Hossam; Nicopoullos, James

doi:10.1016/j.fertnstert.2009.09.059

Cited by 18 publications

(24 citation statements)

References 36 publications

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“…A shorter duration of coasting is also an advantage for the monitoring and cost of the cycle, i.e., a reduced number of visits and blood samples with a shorter duration of coasting. Although the effect of duration of coasting on IVF outcome, i.e., pregnancy and birth rates, is controversial, a significant impairment with a longer duration of coasting cannot be excluded with the available data (17)(18)(19)(20)(21)(22). In the present study, the number of oocytes retrieved was significantly higher in the antagonist group compared with the agonist group; however, pregnancy rates were comparable between groups.…”

Section: Discussioncontrasting

confidence: 53%

Serum Oestradiol Pattern during Coasting is Different in Antagonist Cycles Compared with Long Agonist Cycles in In Vitro Fertilisation

Elter¹,

Özay²,

Ergin³

et al. 2013

Balkan Med J

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Gonadotrophin-releasing hormone (GnRH) agonists and antagonists have been widely used to prevent premature LH surge during ovarian stimulation for in vitro fertilisation (IVF) and embryo transfer (1-3). GnRH agonist suppresses gonadotrophin secretion through both pituitary desensitisation and GnRH receptor down-regulation, whereas GnRH antagonist competes with endogenous GnRH for receptor binding and therefore rapidly inhibits secretion of gonadotrophin (1). It has been suggested that the desensitisation by GnRH agonist has different effects on the intraovarian system than GnRH antagonist (4). Also, GnRH antagonist-treated women showed lower serum and follicular oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration during IVF (5-8). This suggests a difference in ovarian oestradiol metabolism between the two protocols.Coasting, i.e., withholding gonadotropin stimulation whilst continuing pituitary desensitisation for a variable number of days is the most popular strategy for the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation (9). The above-mentioned differences between agonists and antagonists suggest different effects on serum oestradiol levels during coasting. Therefore, in this retrospective analysis, we aimed to compare the change in serum oestradiol levels after withholding the gonadotropins for coasting between long agonist and antagonist cycles. Material and MethodsAntagonist and long luteal agonist cycles, in which coasting was performed, were analysed in this retrospective analysis. Among 4220 cycles between 2001 and 2006, coasting was performed in 115 cycles. Coasting was performed for the indications of: [1] presence of >20 follicles, which were >10 mm in diameter; and/or [2] presence of high (>4000 pg/mL) serum oestradiol level. In all of these cycles, the follicular diameter for the smallest of the three leading follicles was 15 mm. Serum oestradiol levels were determined daily or every other day during coasting until serum oestradiol levels decreased to <4000 pg/mL. Only women between the ages of 21 and 39 years (n=102) were included in the analysis, to match the groups by age. Antagonist cycles (n=50) were compared with long agonist cycles (n=52) with respect to the duration of coasting and the serum oestradiol levels following withholding of gonadotropins. Pregnancy and implantation rates and the rate and severity of OHSS were also compared. The severity of OHSS was determined according to the Golan criteria (10). Cycle characteristics were compared by using the Student's t-test and chi-square test, where appropriate. Continu- ABSTRACTBackground: GnRH agonists and antagonists have different mechanism of action, and therefore serum estradiol levels might differ during coasting in IVF.

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Section: Discussioncontrasting

confidence: 53%

Serum Oestradiol Pattern during Coasting is Different in Antagonist Cycles Compared with Long Agonist Cycles in In Vitro Fertilisation

Elter¹,

Özay²,

Ergin³

et al. 2013

Balkan Med J

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“…In our cases, the reduction of FSH dose could have had a coasting effect. Impairment in oocyte number with prolonged coasting has been reported (8). We have observed this phenomenon occasionally in oocyte donors treated with rFSH, Orgalutran, and GnRH agonist trigger, with multifollicular response, progressive reduction of daily FSH dose, and dropping of plasma E 2 but normal follicular progression, as reported recently by Griesinger et al (9) The embryo quality does not seem to be altered, because in one case pregnancy was achieved in the same cycle, and in the other case with available oocytes, the pregnancy was achieved on the subsequent frozen-thawed embryo transfer.…”

Section: Discussionmentioning

confidence: 99%

GnRH antagonist rescue of a long-protocol IVF cycle and GnRH agonist trigger to avoid ovarian hyperstimulation syndrome: three case reports

Martínez

Rodríguez

Buxaderas

et al. 2011

Fertility and Sterility

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“…The implantation and pregnancy rates were significantly lower if coasting was continued for 4 days or more (11). In a recent retrospective study of 1068 coasted cycles, the authors reported 1.9% severe OHSS, the mean days of coasting was 4.7 days and no effect on the live birth rate was observed with up to 8 days of coasting (17).…”

Section: Coastingmentioning

confidence: 95%

Agonist and antagonist coast

Aboulghar

2012

Fertility and Sterility

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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

Cited by 18 publications

References 36 publications

Serum Oestradiol Pattern during Coasting is Different in Antagonist Cycles Compared with Long Agonist Cycles in In Vitro Fertilisation

Serum Oestradiol Pattern during Coasting is Different in Antagonist Cycles Compared with Long Agonist Cycles in In Vitro Fertilisation

GnRH antagonist rescue of a long-protocol IVF cycle and GnRH agonist trigger to avoid ovarian hyperstimulation syndrome: three case reports

Agonist and antagonist coast

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