title: Agonist and antagonist coast.
abstract: The use of GnRH-a in ovarian stimulation permitted stronger stimulation resulting in an increased incidence of OHSS. The first Cochrane review comparing GnRH agonist and GnRH antagonist protocols for ovarian stimulation showed no significant difference in OHSS rate between the two protocols, however, a recent Cochrane review showed a highly significant decrease in the incidence in OHSS rate in the antagonist protocol. Coasting is a commonly used procedure for preventions of OHSS. The optimum time to start coasting is when the lead follicle reaches 16 mm in diameter and hCG should be given when E2 level drops below 3000 pg/ml. Coasting may act by diminishing the functioning granulosa cell cohort. Administration of daily GnRH antagonist in high risk patients for OHSS who were down-regulated by GnRH-a resulted in rapid drop of E2 and decrease in incidence of OHSS. A series of patients who developed early OHSS were treated by daily GnRH antagonist injections, all embryos were cryopreserved. No progression to severe OHSS was observed.
authors.affiliation: The Egyptian IVF Center, Maadi, Cairo. ghar@link.net
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aboulghar
mesh_terms: D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000378:metabolism; D019317:Evidence-Based Medicine; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control*; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol