Yumuşak Ömer Hamid, Kahyaoğlu Serkan, Özgü Erdinç Ayşe Seval, Yılmaz Saynur, Engin Üstün Yaprak, Yılmaz Nafiye
Zekai Tahir Burak Women's Health Education and Research Hospital, Clinic of Reproductive Endocrinology, Ankara, Turkey.
Zübeyde Hanım Women's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.
Turk J Obstet Gynecol. 2014 Sep;11(3):159-164. doi: 10.4274/tjod.48751. Epub 2014 Sep 15.
Ovarian hyperstimulation syndrome (OHSS) remains as a clinical problem for hyperresponder patients during controlled ovarian hyperstimulation and in vitro fertilization (COH-IVF) procedure. Herein, we aimed to evaluate the COH-IVF outcomes in hyperresponder patients managed with coasting treatment strategy for OHSS prevention regarding the establishment of clinical pregnancy as an endpoint of the treatment cycle.
The medical records related to the COH-IVF outcome in 119 hyperresponder patients who have exhibited a serum estradiol level greater than or equal to 3000 pg/mL were evaluated. The study was conducted on a total of 119 patients, 98 of whom have been treated by coasting or coasting with GnRH antagonist co-treatment strategies, while the remaining 21 women (control group) have not been managed with coasting treatment. The COH and IVF-ET outcomes in the 119 patients were compared based on the coasting treatment situation.
Among the women who received coasting treatment, the number of patients demonstrating E2 level decrement and also E2 level decrement rate after coasting were similar between patients with and without clinical pregnancy. Total gonadotropin dose, 2PN number, embryo number, and fertilization rate were significantly higher in the patients with a clinical pregnancy.
The coasting treatment is a clinically useful preventive strategy for OHSS avoidance. GnRH antagonist co-treatment decreases the duration of coasting although any detrimental or ameliorating impact of this effect on pregnancy rates have not been seen. The E2 level decrement or increment following coasting treatment seems not to be related to cycle outcomes.
卵巢过度刺激综合征（OHSS）仍是高反应患者在控制性卵巢刺激和体外受精（COH-IVF）过程中的一个临床问题。在此，我们旨在评估采用“降调节”治疗策略预防OHSS的高反应患者的COH-IVF结局，将临床妊娠的建立作为治疗周期的终点。
评估了119例血清雌二醇水平大于或等于3000 pg/mL的高反应患者的COH-IVF结局的医疗记录。该研究共纳入119例患者，其中98例采用“降调节”或“降调节”联合GnRH拮抗剂共同治疗策略，其余21例女性（对照组）未采用“降调节”治疗。根据“降调节”治疗情况比较119例患者的COH和IVF-ET结局。
在接受“降调节”治疗的女性中，有临床妊娠和无临床妊娠的患者中出现E2水平下降的患者数量以及“降调节”后的E2水平下降率相似。有临床妊娠的患者总促性腺激素剂量、2PN数量、胚胎数量和受精率显著更高。
“降调节”治疗是一种临床上有用的预防OHSS的策略。GnRH拮抗剂联合治疗可缩短“降调节”的持续时间，尽管尚未观察到这种作用对妊娠率有任何有害或改善影响。“降调节”治疗后E2水平的下降或升高似乎与周期结局无关。
