Dhont M, Van der Straeten F, De Sutter P
Department of Obstetrics and Gynaecology, University Hospital, Ghent, Belgium.
Fertil Steril. 1998 Nov;70(5):847-50. doi: 10.1016/s0015-0282(98)00280-5.
To evaluate the efficiency of withholding gonadotropins and deferring the administration of hCG until E2 levels start dropping (coasting) in the prevention of ovarian hyperstimulation syndrome (OHSS) in a high-risk population.
Retrospective case-control study.
In vitro fertilization program at a university center.
PATIENT(S): The case group consisted of 120 women undergoing ovarian stimulation for IVF who were considered to be at risk for ovarian hyperstimulation (serum E2 levels >2,500 pg/mL or >20 follicles at the time of hCG administration).
INTERVENTION(S): Gonadotropin administration was withheld when serum E2 levels exceeded 2,500 pg/mL, and hCG administration was delayed until E2 levels dropped below 2,500 pg/mL. Outcomes were compared with those from 120 matched patients in whom serum E2 levels and the number of follicles at the time of hCG administration were comparable to those at the beginning of coasting (control group).
MAIN OUTCOME MEASURE(S): Incidence of moderate and severe OHSS. The number of oocytes retrieved and pregnancy rate (PR) were compared in both groups.
RESULT(S): Coasting decreased the incidence of moderate and severe OHSS. The odds ratio of severe OHSS in the coasting group was 0.11 (95% confidence interval 0.01-0.86). Although the number of oocytes was significantly lower in the coasting group (19.7 +/- 0.6 versus 22.1 +/- 0.6), coasting did not affect the PR (37.5% versus 36.7%).
CONCLUSION(S): Our study indicates that coasting is an efficient method for reducing the incidence and severity of OHSS without compromising the PR.
评估在高危人群中，在促性腺激素水平开始下降（“coasting”）之前停用促性腺激素并推迟人绒毛膜促性腺激素（hCG）给药，以预防卵巢过度刺激综合征（OHSS）的有效性。
回顾性病例对照研究。
某大学中心的体外受精项目。
病例组由120名接受体外受精卵巢刺激的女性组成，她们被认为有卵巢过度刺激风险（hCG给药时血清雌二醇（E2）水平>2500 pg/mL或卵泡数>20个）。
当血清E2水平超过2500 pg/mL时停用促性腺激素，hCG给药推迟至E2水平降至2500 pg/mL以下。将结果与120名匹配患者（hCG给药时血清E2水平和卵泡数与“coasting”开始时相当）的结果进行比较（对照组）。
中度和重度OHSS的发生率。比较两组的取卵数和妊娠率（PR）。
“coasting”降低了中度和重度OHSS的发生率。“coasting”组重度OHSS的优势比为0.11（95%置信区间0.01 - 0.86）。虽然“coasting”组的卵母细胞数明显较低（19.7±0.6对22.1±0.6），但“coasting”不影响妊娠率（37.5%对36.7%）。
我们的研究表明，“coasting”是一种有效降低OHSS发生率和严重程度且不影响妊娠率的方法。
