Prevention of severe ovarian hyperstimulation syndrome in IVF with or without ICSI and embryo transfer: a modified 'coasting' strategy based on ultrasound for identification of high-risk patients.
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.
Al-Shawaf
T
T
Fertility Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. talhayas@aol.com
Zosmer
A
A
Hussain
S
S
Tozer
A
A
Panay
N
N
Wilson
C
C
Lower
A M
AM
Grudzinskas
J G
JG
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D008297:Male; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D016471:Ovarian Hyperstimulation Syndrome / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome; D014463:Ultrasonography
D006063:Chorionic Gonadotropin; D004958:Estradiol