Eliminating the risk of life-endangering complications following overstimulation with menotropin fertility agents: a report on women undergoing in vitro fertilization and embryo transfer.
OBJECTIVE
To evaluate a new method for preventing the life-endangering complications associated with inadvertent menotropin-induced severe ovarian hyperstimulation in patients undergoing in vitro fertilization and embryo transfer (IVF-ET).


METHODS
Seventeen women each underwent a single cycle of controlled ovarian hyperstimulation with menotropins in preparation for IVF-ET. The indications for IVF-ET were tubal occlusion in nine, endometriosis in six, and unexplained infertility in two. The peak plasma estradiol (E2) concentration before hCG administration was greater than 6000 pg/mL and more than 30 ovarian follicles were detected by transvaginal ultrasound. Thus, life-endangering complications associated with severe ovarian hyperstimulation syndrome were highly likely to occur following hCG administration. Rather than cancel the cycle of treatment, menotropin therapy was discontinued and hCG administration was deferred for a number of days until the plasma E2 concentration fell below 3000 pg/mL ("prolonged coasting"), whereupon hCG was administered and egg retrievals and ETs were duly performed.


RESULTS
None of the women developed severe ovarian hyperstimulation syndrome. There were six viable pregnancies (35.2%), which proceeded normally.


CONCLUSIONS
This study indicates that "prolonged coasting" prevents severe ovarian hyperstimulation syndrome in severely overstimulated women undergoing IVF-ET, without necessitating cycle cancellation.
Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Reno.
G
G
Sher
R
R
Salem
M
M
Feinman
S
S
Dodge
C
C
Zouves
V
V
Knutzen
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008596:Menotropins / Q000627:therapeutic use*; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control*; D013997:Time Factors
D006063:Chorionic Gonadotropin; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone; D016729:Leuprolide