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Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndromeD'Angelo A, Amso NN
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SummaryNot enough evidence from trials to show whether withholding gonadotrophins ('coasting') after ovulation in IVF prevents OHSS (ovarian hyperstimulation syndrome)Ovarian hyperstimulation syndrome (OHSS) is a complication of using hormones to induce ovulation (the release of eggs) in IVF (in vitro fertilisation). This can sometimes over-stimulate ovaries. Severe OHSS can be life threatening. One method used to try and reduce the risk of OHSS is 'coasting' or 'prolonged coasting'. This involves withholding one hormone (gonadotrophin) before ovulation. The review did not find enough evidence from trials to show whether coasting can affect the chances of OHSS (or pregnancy). Other methods such as using frozen embryos and/or intravenous albumin infusion (artificial fluid to increase the woman's blood volume) may be more effective.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 22. 2002 AbstractBackgroundOvarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Its reported incidence varies from 1% to 10% of in vitro fertilization (IVF) cycles. The factors contributing to OHSS have not been completely explained. It seems likely that the release of vasoactive substances, secreted by the ovaries under human chorionic gonadotropin (hCG) stimulation plays a key role in triggering this syndrome. This condition is characterised by a massive shift of fluid from the intra-vascular compartment to the third space resulting in profound intra-vascular depletion and hemoconcentration. ObjectivesTo assess the effect of 'coasting' (withholding gonadotrophins) as a preventive strategy in the management of OHSS following superovulation in assisted reproduction treatment on the incidence of all clinical grades of OHSS, in comparison with early unilateral follicular aspiration (EUFA" or other interventions. Search strategyWe searched the Cochrane Menstrual Disorders and Subfertility Review Group trials register (searched 3 Feb 2005) MEDLINE (PUBMED) (1985 to 2004), EMBASE (1985 to 2001), CINAHL (1985 to 2001), National Research Register for randomised controlled trials (RCTs) in which coasting was used to prevent OHSS. Selection criteriaWe included randomised controlled trials (RCTs) in which coasting was used to prevent OHSS. Data collection and analysisTwo reviewers selected trials and extracted data independently. Disagreements were resolved by discussion. We contacted study authors to request additional information on the trial methodology or data. The interventions compared were coasting versus early unilateral follicular aspiration (EUFA) or no coasting or other interventions. Statistical analysis was performed in accordance with the Cochrane Menstrual Disorders and Subfertility Group guidelines. Main resultsThis review identified thirteen studies of which only one trial met the inclusion criteria. There was no difference in the incidence of moderate and severe OHSS (n = 30, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.18 to 3.24) and in the clinical pregnancy rate (n = 30, OR 0.75, 95% CI 0.17 to 3.33) between the groups. Authors' conclusionsThere is a lack of randomised controlled trials comparing coasting with no coasting or other interventions such as embryo freezing or intravenous albumin infusion for prevention of OHSS. There is insufficient evidence to determine whether coasting is an effective strategy for preventing OHSS. |