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Related Experiment Videos

Coasting-what is the best formula?

O Levinsohn-Tavor1, S Friedler, M Schachter

  • 1IVF and Infertility Unit, Department of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Human Reproduction (Oxford, England)
|May 2, 2003
PubMed
Summary
This summary is machine-generated.

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To reduce ovarian hyperstimulation syndrome (OHSS), coasting involves pausing gonadotrophins. This strategy is most effective when initiated with specific estradiol levels and follicle size, limited to under four days, and ending when estradiol falls below 3000 pg/ml.

Area of Science:

  • Reproductive Endocrinology
  • Infertility Treatment
  • Clinical Protocols

Background:

  • Ovarian hyperstimulation syndrome (OHSS) is a risk in assisted reproductive technology.
  • Coasting, a method to mitigate OHSS, has variable application and inconsistent efficacy reports.
  • Lack of standardized coasting protocols hinders optimal patient outcomes.

Purpose of the Study:

  • To establish a recommended protocol for the coasting strategy in assisted reproduction.
  • To analyze existing literature to define optimal initiation, duration, and cessation criteria for coasting.
  • To improve the safety and efficacy of coasting in preventing severe OHSS.

Main Methods:

  • Systematic review and analysis of 10 relevant studies identified through a Medline search.

Related Experiment Videos

  • Evaluation of heterogeneous criteria for initiating and ending the coasting process.
  • Data synthesis to determine optimal serum estradiol (E2) levels and follicle size for coasting initiation and cessation.

    • Main Results:

    • Recommended coasting initiation: serum E2 > 3000 pg/ml and leading follicles ≥ 15-18 mm.
    • Recommended coasting duration: < 4 days to maintain implantation and pregnancy rates.
    • Recommended hCG administration: withheld until serum E2 < 3000 pg/ml.
    • Suggested guidelines yield <2% severe OHSS and satisfactory fertilization (55-71%) and pregnancy (36.5-63%) rates.

    Conclusions:

    • Standardized coasting protocols can significantly reduce severe OHSS incidence.
    • Adherence to proposed guidelines ensures acceptable pregnancy and fertilization rates.
    • Further multicenter randomized prospective studies are needed to validate these findings.