Coasting Decreases Ovarian Hyperstimulation Syndrome in Patients at Risk. Is the Quality of Oocytes, Embryos and Pregnancy Rate the Price to Pay?

2005 ◽  
Vol 84 ◽  
pp. S300 ◽  
Author(s):  
J. Grace ◽  
B. Rizk ◽  
M. Mulekar

Intraduction: Ovarian hyperstimulation syndrome (OHSS) is very serius complication of in vitro fertilisation (IVF) treatments. Human chorionic gonadotrophine (hCG) is the trigger factor of the syndrome. Gonadotrophine releasing hormone agonist (GnRHa) can use instead of hCG for triggering the ovulation. Matherial and Methods: This study aims to evaluate the effects of ovulation triggering with Gonadotrophine Releasing Hormone Agonists (GnRHa) on ovarian hyperstimulation syndrome (OHSS) rates and pregnancy success in patients at risk of OHSS. 51 cycles were evaluated in 50 women. Gonadotrophine (Gn) was applied to all patients with a flexible GnRHa protocol. To trigger ovulation, 0.2 mg triptorelin was applied when the estradiol level was 3500-7000 pg/mL and/or when at least 18 follicles were determined at ≥10mm. Oocyte Pick-Up (OPU) was performed 35 hours after the triptorelin injection. Within 1 hour of OPU, luteal support with 1500 IU hCG was administered to the patients and on the night of OPU, vaginal progesterone and oral estrogen were started. Results: OHSS was determined in 5 cycles (9.8%), and 4 of them (7.8%) were early OHSS. Embryo transfer was applied in 49 cycles. The pregnancy rate was determined as 44.9%, clinical pregnancy rate as 26.5%, continuing pregnancy rate as 24.4% and the abortus rate as 2%. Conclusion: GnRHa triggering applied before treatment to patients at risk of early OHSS does not completely eliminate the risk of OHSS. Nevertheless, this protocol improved treatment results without increasing the rates of severe OHSS.


2006 ◽  
Vol 86 (6) ◽  
pp. 1773-1775 ◽  
Author(s):  
Srinivasan Vyjayanthi ◽  
Tommy Tang ◽  
Azza Fattah ◽  
Maruthini Deivanayagam ◽  
Nick Bardis ◽  
...  

2001 ◽  
Vol 16 (1) ◽  
pp. 24-30 ◽  
Author(s):  
T. Al-Shawaf ◽  
A. Zosmer ◽  
S. Hussain ◽  
A. Tozer ◽  
N. Panay ◽  
...  

Abstract Ovarian hyperstimulation syndrome (OHSS) can be a severe and potentially life-threatening complication of ovarian stimulation for IVF. Coasting or withholding gonadotrophin stimulation relies on frequent estimation of serum oestradiol to identify patients at risk. A modified coasting protocol was developed in which identification of patients at risk of severe OHSS was based on ultrasound monitoring. Serum oestradiol concentrations were measured only in patients with >20 follicles on ultrasound (high risk). If serum oestradiol concentrations were <3000 pmol/l, the gonadotrophin dose was maintained; if concentrations were ≥3000 pmol/l but <13200 pmol/l and ≥25% of the follicles had a diameter of ≥13 mm, the gonadotrophin dose was halved; and if serum oestradiol concentrations were ≥13 200 pmol/l and ≥25% of the follicles had a diameter of ≥15 mm, patients were coasted. In the latter group, human chorionic gonadotrophin (HCG) 10000 IU was administered when at least three follicles had a diameter of ≥18 mm and serum oestradiol concentrations were <10000 pmol/l. Over a 10 month period, serum oestradiol concentrations were measured in 123 out of 580 cycles (24%) and in 50 cycles, gonadotrophins were withheld. Overall, moderate OHSS occurred in three patients (0.7%) and severe OHSS in one patient (0.2%). The pregnancy rates in the cycles where the gonadotrophin dose was reduced or withheld were 39.6 and 40% per cycle respectively; corresponding implantation rates were 30.7 and 25.6%. It is concluded that the modified coasting strategy is associated with a low risk of moderate and severe OHSS to a minimum without compromising pregnancy rates. Identification of patients at risk by ultrasound reduces the number of serum oestradiol measurements and thus inconvenience to patients as well as costs and workload.


2013 ◽  
Vol 100 (3) ◽  
pp. S177-S178
Author(s):  
A. Mifsud ◽  
M-J. Escriba ◽  
M-J. De los Santos ◽  
J. Remohí ◽  
A. Galan ◽  
...  

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