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Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome

  • Comment
  • Review
  • Intervention

Authors


Abstract

Background

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Reported incidence varies from 1% to 10% of in vitro fertilization (IVF) cycles. The factors contributing to OHSS have not been completely explained. The release of vasoactive substances secreted by the ovaries under human chorionic gonadotrophin (hCG) stimulation may play a key role in triggering this syndrome. This condition is characterised by a massive shift of fluid from the intra-vascular compartment to the third space resulting in profound intra-vascular depletion and haemoconcentration.

Objectives

To assess the effect of withholding gonadotrophins (coasting) on the prevention of ovarian hyperstimulation syndrome in assisted reproduction cycles.

Search methods

For the update of this review we searched the Cochrane Menstrual Disorders and Subfertility Review Group Trials Register (July 2010), CENTRAL (inception to July 2010), MEDLINE (PubMed) (inception to July 2010), and EMBASE (inception to July 2010) for randomised controlled trials (RCTs) in which coasting was used to prevent OHSS.

Selection criteria

Only randomised controlled trials (RCTs) in which coasting was used to prevent OHSS were included.

Data collection and analysis

Two review authors independently selected trials and extracted data. Disagreements were resolved by discussion. Study authors were contacted to request additional information or missing data. The intervention comparisons were coasting versus early unilateral follicular aspiration (EUFA), no coasting or other interventions. Statistical analysis was performed in accordance with the Cochrane Menstrual Disorders and Subfertility Group guidelines.

Main results

This updated review identified 16 studies of which four met the inclusion criteria.

There was very low quality evidence to suggest a benefit of coasting over no coasting for a reduction in moderate to severe OHSS (OR 0.17, 95% CI 0.03 to 0.88, one RCT, 68 women).

There was no evidence of a difference in the incidence of moderate to severe OHSS when coasting was compared with early unilateral follicular aspiration or GnRHa. There was no evidence to suggest a benefit in live birth from coasting compared with no coasting, although the data were from a single trial only. Trials of other comparisons did not report live birth.

Authors' conclusions

There was very low quality evidence to suggest a benefit of coasting over no coasting for a reduction in moderate to severe OHSS. There was no evidence to suggest a benefit of using coasting to prevent OHSS compared with other interventions.

Plain language summary

Coasting (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a complication of using hormones to induce ovulation (the release of eggs) in IVF (in vitro fertilization). The hormones can sometimes over-stimulate the ovaries. Severe OHSS can be life threatening. One method used to try and reduce the risk of OHSS is 'coasting' or 'prolonged coasting'. This involves withholding one hormone (gonadotrophin) before ovulation. There was very low quality evidence to suggest a benefit of coasting over no coasting for a reduction in moderate to severe OHSS. There was no evidence of a difference in the incidence of moderate to severe OHSS when coasting was compared with other interventions. There was no evidence to suggest a benefit in live birth from coasting compared with no coasting, although the data were from a single trial only. Trials of other comparisons did not report live birth.

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