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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 de...
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| Published in: | Human reproduction (Oxford) 2001-01, Vol.16 (1), p.24-30 |
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| container_title | Human reproduction (Oxford) |
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| creator | Al-Shawaf, T. Zosmer, A. Hussain, S. Tozer, A. Panay, N. Wilson, C. Lower, A.M. Grudzinskas, J.G. |
| description | 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 |
| doi_str_mv | 10.1093/humrep/16.1.24 |
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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.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/16.1.24</identifier><identifier>PMID: 11139531</identifier><identifier>CODEN: HUREEE</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Biological and medical sciences ; Chorionic Gonadotropin - administration & dosage ; coasting ; Embryo Transfer ; Estradiol - blood ; Female ; Female genital diseases ; Fertilization in Vitro - adverse effects ; Gynecology. Andrology. Obstetrics ; Humans ; Male ; Medical sciences ; Non tumoral diseases ; oestradiol ; Ovarian Follicle - diagnostic imaging ; ovarian hyperstimulation syndrome ; Ovarian Hyperstimulation Syndrome - diagnostic imaging ; Ovarian Hyperstimulation Syndrome - prevention & control ; ovarian stimulation ; Ovulation Induction - adverse effects ; Pregnancy ; Risk Factors ; Sperm Injections, Intracytoplasmic ; Treatment Outcome ; Ultrasonography ; ultrasound</subject><ispartof>Human reproduction (Oxford), 2001-01, Vol.16 (1), p.24-30</ispartof><rights>European Society of Human Reproduction and Embryology 2001</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391t-c5731241537e1f7166058a231e5c53bd9e2d0260efc4f1d17b4dc9987128971b3</citedby><cites>FETCH-LOGICAL-c391t-c5731241537e1f7166058a231e5c53bd9e2d0260efc4f1d17b4dc9987128971b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=855229$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11139531$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al-Shawaf, T.</creatorcontrib><creatorcontrib>Zosmer, A.</creatorcontrib><creatorcontrib>Hussain, S.</creatorcontrib><creatorcontrib>Tozer, A.</creatorcontrib><creatorcontrib>Panay, N.</creatorcontrib><creatorcontrib>Wilson, C.</creatorcontrib><creatorcontrib>Lower, A.M.</creatorcontrib><creatorcontrib>Grudzinskas, J.G.</creatorcontrib><title>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</title><title>Human reproduction (Oxford)</title><addtitle>Hum. Reprod</addtitle><addtitle>Hum. Reprod</addtitle><description>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.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Chorionic Gonadotropin - administration & dosage</subject><subject>coasting</subject><subject>Embryo Transfer</subject><subject>Estradiol - blood</subject><subject>Female</subject><subject>Female genital diseases</subject><subject>Fertilization in Vitro - adverse effects</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Non tumoral diseases</subject><subject>oestradiol</subject><subject>Ovarian Follicle - diagnostic imaging</subject><subject>ovarian hyperstimulation syndrome</subject><subject>Ovarian Hyperstimulation Syndrome - diagnostic imaging</subject><subject>Ovarian Hyperstimulation Syndrome - prevention & control</subject><subject>ovarian stimulation</subject><subject>Ovulation Induction - adverse effects</subject><subject>Pregnancy</subject><subject>Risk Factors</subject><subject>Sperm Injections, Intracytoplasmic</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><subject>ultrasound</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNqFkU1v1DAQhiMEokvhyhFZQgJxyNYTx_nghlYsXVSg4kuIi3Gc8cY0iYOdFPL7-GO4zVKOnGY88_id0bxR9BDoGmjJTpqpczicQLaGdZLeilaQZjROGKe3oxVNsiIGyOAouuf9d0pDWmR3oyMAYCVnsIp-nzu8xH40tidWEx8eDom9lM7InjTzgM6PpptaeY34ua-d7ZCYnuw-b8lPMzbEuutop5HsNh92RPY1wa5ysyWjk73X6J4TSTpbG22wJt-UlUG03z8lPgAj7mdSSR86YcLUhpK3U9DQQdjUV8tpo-TfFRuzb2Jn_AUZQi10_f3ojpatxweHeBx92r78uDmNz9692m1enMWKlTDGiucMkhQ4yxF0DllGeSETBsgVZ1VdYlKHi1HUKtVQQ16ltSrLIoekKHOo2HH0ZNEdnP0xoR9FZ7zCtpU92smLPOhRzrIArhdQOeu9Qy0GZzrpZgFUXNkmFtsEZAJEkoYPjw7KU9Vh_Q8_-BSAxwdAeiVbHc6qjL_hCs6TpAzUs4Wy0_D_kfHCGj_irxtauguR5Szn4vTLVwF8W74_f_tavGF_ABg9wkk</recordid><startdate>200101</startdate><enddate>200101</enddate><creator>Al-Shawaf, T.</creator><creator>Zosmer, A.</creator><creator>Hussain, S.</creator><creator>Tozer, A.</creator><creator>Panay, N.</creator><creator>Wilson, C.</creator><creator>Lower, A.M.</creator><creator>Grudzinskas, J.G.</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200101</creationdate><title>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</title><author>Al-Shawaf, T. ; Zosmer, A. ; Hussain, S. ; Tozer, A. ; Panay, N. ; Wilson, C. ; Lower, A.M. ; Grudzinskas, J.G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-c5731241537e1f7166058a231e5c53bd9e2d0260efc4f1d17b4dc9987128971b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Chorionic Gonadotropin - administration & dosage</topic><topic>coasting</topic><topic>Embryo Transfer</topic><topic>Estradiol - blood</topic><topic>Female</topic><topic>Female genital diseases</topic><topic>Fertilization in Vitro - adverse effects</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Non tumoral diseases</topic><topic>oestradiol</topic><topic>Ovarian Follicle - diagnostic imaging</topic><topic>ovarian hyperstimulation syndrome</topic><topic>Ovarian Hyperstimulation Syndrome - diagnostic imaging</topic><topic>Ovarian Hyperstimulation Syndrome - prevention & control</topic><topic>ovarian stimulation</topic><topic>Ovulation Induction - adverse effects</topic><topic>Pregnancy</topic><topic>Risk Factors</topic><topic>Sperm Injections, Intracytoplasmic</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><topic>ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Al-Shawaf, T.</creatorcontrib><creatorcontrib>Zosmer, A.</creatorcontrib><creatorcontrib>Hussain, S.</creatorcontrib><creatorcontrib>Tozer, A.</creatorcontrib><creatorcontrib>Panay, N.</creatorcontrib><creatorcontrib>Wilson, C.</creatorcontrib><creatorcontrib>Lower, A.M.</creatorcontrib><creatorcontrib>Grudzinskas, J.G.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Al-Shawaf, T.</au><au>Zosmer, A.</au><au>Hussain, S.</au><au>Tozer, A.</au><au>Panay, N.</au><au>Wilson, C.</au><au>Lower, A.M.</au><au>Grudzinskas, J.G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Human reproduction (Oxford)</jtitle><stitle>Hum. Reprod</stitle><addtitle>Hum. Reprod</addtitle><date>2001-01</date><risdate>2001</risdate><volume>16</volume><issue>1</issue><spage>24</spage><epage>30</epage><pages>24-30</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><coden>HUREEE</coden><abstract>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.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>11139531</pmid><doi>10.1093/humrep/16.1.24</doi><tpages>7</tpages></addata></record> |
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| source | Oxford Journals Online |
| subjects | Adult Biological and medical sciences Chorionic Gonadotropin - administration & dosage coasting Embryo Transfer Estradiol - blood Female Female genital diseases Fertilization in Vitro - adverse effects Gynecology. Andrology. Obstetrics Humans Male Medical sciences Non tumoral diseases oestradiol Ovarian Follicle - diagnostic imaging ovarian hyperstimulation syndrome Ovarian Hyperstimulation Syndrome - diagnostic imaging Ovarian Hyperstimulation Syndrome - prevention & control ovarian stimulation Ovulation Induction - adverse effects Pregnancy Risk Factors Sperm Injections, Intracytoplasmic Treatment Outcome Ultrasonography ultrasound |
| title | 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 |
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