The effects of 'coasting' on follicular fluid concentrations of vascular endothelial growth factor in women at risk of developing ovarian hyperstimulation syndrome.
BACKGROUND
The aim of this study was to assess the effect of withholding gonadotrophins (coasting) during controlled ovarian stimulation (COS) on individual follicle concentrations of follicular fluid vascular endothelial growth factor (VEGF) in women at high risk of developing ovarian hyperstimulation syndrome (OHSS).


METHODS
Twenty-two women who had been coasted and 26 optimally responding women (control group) undergoing COS for IVF were studied. At the time of oocyte retrieval, the follicular fluid from four to six individual follicles of different sizes was collected for VEGF analysis.


RESULTS
A total of 118 follicles was analysed in the coasted group and 137 in the control group. A negative correlation was observed between the follicle size and VEGF concentration (r = -0.18, P = 0.03) in the control group, which was not seen in the coasted group. Similarly, the correlation between oestradiol (E(2)) and VEGF (r = 0.4, P < 0.0001) observed in the control group was not apparent in the coasted group. Significantly lower concentrations of VEGF were seen in the follicular fluid of the coasted patients.


CONCLUSIONS
It is clear that there are differences in follicular fluid VEGF concentrations between the two groups. It is possible that coasting alters the capacity of the granulosa cells to produce VEGF and/or their response to hCG and in this way acts to reduce the severity and incidence of severe OHSS.
Williamson Laboratory, St Bartholomew's and The London Hospitals Trust, London EC1A, UK.
A J
AJ
Tozer
R K
RK
Iles
E
E
Iammarrone
C M Y
CM
Gillott
T
T
Al-Shawaf
J G
JG
Grudzinskas
D000328:Adult; D002452:Cell Count; D004334:Drug Administration Schedule; D004622:Embryo, Mammalian / Q000502:physiology; D004958:Estradiol / Q000378:metabolism; D005260:Female; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000378:metabolism*; D006062:Gonadotropins / Q000008:administration & dosage*; D006107:Granulosa Cells / Q000166:cytology; D006801:Humans; D009865:Oocytes; D009929:Organ Size; D009994:Osmolar Concentration; D006080:Ovarian Follicle / Q000033:anatomy & histology / Q000378:metabolism*; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010062:Ovulation Induction / Q000009:adverse effects*; D011374:Progesterone / Q000378:metabolism; D012307:Risk Factors; D020858:Tissue and Organ Harvesting; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
D006062:Gonadotropins; D042461:Vascular Endothelial Growth Factor A; D011374:Progesterone; D004958:Estradiol