Kailasam Chandra, Griffith Heather, Wilson Paul, Gordon Uma
Bristol Centre for Reproductive Medicine Bristol United Kingdom Bristol Centre for Reproductive Medicine, Bristol, United Kingdom.
JBRA Assist Reprod. 2018 Nov 1;22(4):301-306. doi: 10.5935/1518-0557.20180053.
Coasting is a well-known strategy to decrease severity of Ovarian Hyperstimulation Syndrome (OHSS). The purpose of this study is to assess the effect of Coasting on blastocyst development and subsequent clinical outcome following exclusive blastocyst transfer.
We conducted an observational cohort study of patients having blastocyst transfer following IVF/ICSI treatment. Patients undergoing IVF/ICSI cycles were included in the study. Patients at risk of OHSS were coasted. Outcome following exclusive blastocyst transfer was compared between coasted and non-coasted groups. The main outcome measures were the rate of blastocyst development and live birth rates in coasted and non-coasted cycles. Within coasted cycles, outcome was further analysed based on coasting duration and serum estradiol (E2) drop (difference between peak E2 and E2 on day of HCG).
A total of 166 coasted cycles and 656 non-coasted cycles had blastocyst transfer. Blastocyst development (45.97% vs. 48.6%) and live birth rates (45.18% vs. 43.44%) were not significantly different between coasted and non-coasted cycles. The overall clinical pregnancy (54.21% vs. 49.08%) and implantation rates (43.95% vs. 39.54%) following blastocyst transfer in coasted cycles were not significantly different from those of non-coasted cycles.
Coasting duration up to 6 days and drop in serum E2 levels did not compromise blastocyst development, implantation, clinical pregnancy or live birth rates. We conclude that coasting with subsequent blastocyst transfer can be used as an effective strategy in patients at risk of OHSS with no detrimental effects on blastocyst development or live birth outcome.
“ coasting”是一种降低卵巢过度刺激综合征（OHSS）严重程度的著名策略。本研究的目的是评估“ coasting”对囊胚发育以及单纯囊胚移植后的后续临床结局的影响。
我们对接受体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗后进行囊胚移植的患者进行了一项观察性队列研究。纳入接受IVF/ICSI周期治疗的患者。有OHSS风险的患者进行“ coasting”。比较“ coasting”组和非“ coasting”组单纯囊胚移植后的结局。主要结局指标是“ coasting”周期和非“ coasting”周期的囊胚发育率和活产率。在“ coasting”周期内，根据“ coasting”持续时间和血清雌二醇（E2）下降情况（E2峰值与HCG日的E2之间的差异）进一步分析结局。
共有166个“ coasting”周期和656个非“ coasting”周期进行了囊胚移植。“ coasting”周期和非“ coasting”周期之间的囊胚发育率（45.97%对48.6%）和活产率（45.18%对43.44%）无显著差异。“ coasting”周期囊胚移植后的总体临床妊娠率（54.21%对49.08%）和着床率（43.95%对39.54%）与非“ coasting”周期无显著差异。
长达6天的“ coasting”持续时间和血清E2水平下降并未损害囊胚发育、着床、临床妊娠或活产率。我们得出结论，对于有OHSS风险的患者，随后进行囊胚移植的“ coasting”可作为一种有效策略，对囊胚发育或活产结局无不利影响。
