The Effect of Coasting on Intracytoplasmic Sperm Injection
Outcome in Antagonist and Agonist Cycle

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Abstract

Background

Coasting can reduce the ovarian hyperstimulation syndrome (OHSS) risk in ovulation induction cycles before intracytoplasmic sperm injection (ICSI). This study aimed to investigate the effect of gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols to controlled ovarian hyperstimulation (COH) cycles with coasting on the parameters of ICSI cycles and the outcome.

Materials and Methods

In a retrospective cohort study, 117 ICSI cycles were per- formed and coasting was applied due to hyperresponse, between 2006 and 2011. The ICSI outcomes after coasting were then compared between the GnRH agonist group (n=91) and the GnRH antagonist group (n=26).

Results

The duration of induction and the total consumption of gonadotropins were found to be similar. Estradiol (E ₂) levels on human chorionic gonadotropin (hCG) day were found higher in the agonist group. Coasting days were similar when the two groups were compared. The number of mature oocytes and the fertilization rates were similar in both groups; however, the number of grade 1 (G1) embryos and the number of transferred embryos were higher in the agonist group. Implantation rates were significantly higher in the antagonist group compared to the agonist group. Pregnancy rates/embryo transfer rates were higher in the antagonist group; however, this difference was not statistically significant (32.8% for agonist group vs. 39.1% for antagonist group, P>0.05).

Conclusion

The present study showed that applying GnRH-agonist and GnRH-antago- nist protocols to coasted cycles did not result in any differences in cycle parameters and clinical pregnancy rates.

Related collections

Most cited references 26

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Preventing ovarian hyperstimulation syndrome: guidance for the clinician.

Peter Humaidan, Jens Quartarolo, Evangelos Papanikolaou (2010)

To reevaluate ovarian hyperstimulation syndrome (OHSS) prevention techniques and provide a classification system for grading OHSS and evidence-based treatment strategies for preventing OHSS. A literature search was conducted in PubMed for articles published in the last 5 years using the keywords "controlled ovarian stimulation," "controlled ovarian hyperstimulation," "ovarian hyperstimulation syndrome," "OHSS," "prevention," "chorionic gonadotropin," "hCG," "GnRH agonist," "GnRH antagonist," "coasting," and "cryopreservation." We reviewed randomized controlled trials (RCTs), retrospective studies, pilot studies, case studies, reviews, and meta-analyses. There is a shortage of large, prospective RCTs reporting OHSS prediction and prevention strategies. Our review showed that risk factors such as antral follicle count and baseline anti-Müllerian hormone level may identify women at high OHSS risk. Preventative strategies that appear highly effective at reducing or preventing OHSS include GnRH antagonist protocols and the use of GnRH agonists to trigger final oocyte maturation. Moreover, alternative therapies, such as dopamine receptor agonists (Cabergoline), have also emerged as potential new treatment modalities in the management of this disease. These findings suggest that current treatment guidelines should be updated to incorporate findings from recent literature that show that GnRH antagonist protocols consistently reduce OHSS and that GnRH agonist triggering has considerable promise in preventing OHSS, although further RCTs will be needed to confirm this. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

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Are GnRH antagonists comparable to agonists for use in IVF?

J. A. F. Huirne, Nils Lambalk, R Homburg (2007)

We believe that appropriate comparison of optimal GnRH agonist and antagonist regimens has not been performed yet. Currently available meta-analyses included all comparative studies between GnRH agonists and antagonists performed so far, including less than optimal GnRH antagonist regimens. After critical appraisal of the various studied GnRH antagonist regimens in terms of follicular development and IVF outcome, we postulate that early suppression of endogenous FSH results in optimal follicular development. Additionally, stable and early suppression of LH and progesterone levels during the entire period of stimulation may be an advantage for implantation and pregnancy outcome. In this respect, single dose and particularly flexible protocols seem to be less advantageous. Early FSH and LH suppression can be achieved by early GnRH antagonist administration (stimulation day 1) or by oral contraceptive (OC) pretreatment. More studies comparing long GnRH agonist protocols with 'long' GnRH antagonist protocols, with enough power to identify differences in pregnancy rates, are required before appropriate comparison can be made.

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Is Open Access

Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment

Klaus Fiedler, Diego Ezcurra (2012)

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COS) as part of assisted reproductive technologies (ART). While the safety and efficacy of ART is well established, physicians should always be aware of the risk of OHSS in patients undergoing COS, as it can be fatal. This article will briefly present the pathophysiology of OHSS, including the key role of vascular endothelial growth factor (VEGF), to provide the foundation for an overview of current techniques for the prevention of OHSS. Risk factors and predictive factors for OHSS will be presented, as recognizing these risk factors and individualizing the COS protocol appropriately is the key to the primary prevention of OHSS, as the benefits and risks of each COS strategy vary among individuals. Individualized COS (iCOS) could effectively eradicate OHSS, and the identification of hormonal, functional and genetic markers of ovarian response will facilitate iCOS. However, if iCOS is not properly applied, various preventive measures can be instituted once COS has begun, including cancelling the cycle, coasting, individualizing the human chorionic gonadotropin trigger dose or using a gonadotropin-releasing hormone (GnRH) agonist (for those using a GnRH antagonist protocol), the use of intravenous fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all embryos for subsequent transfer in an unstimulated cycle. Some of these techniques have been widely adopted, despite the scarcity of data from randomized clinical trials to support their use.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Fertil Steril

Journal ID (iso-abbrev): Int J Fertil Steril

Journal ID (publisher-id): Royan Institute

Title: International Journal of Fertility & Sterility

Publisher: Royan Institute

ISSN (Print): 2008-076X

ISSN (Electronic): 2008-0778

Publication date (Print): Apr-Jun 2017

Publication date (Electronic): 11 November 2016

Volume: 11

Issue: 1

Pages: 1-6

Affiliations

[1 ]Department of Obstetrics and Gynaecology, School of Medicine, Turgut Ozal University, Ankara, Turkey

[2 ]Department of IVF-Embriology, School of Medicine, Turgut Ozal University, Ankara, Turkey

[3 ]Department of Obstetrics and Gynaecology, School of Medicine, Gazi University, Ankara, Turkey

[4 ]Department of Obstetrics and Gynaecology, School of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey

Author notes

[*Corresponding Address: ]Department of Obstetrics and GynaecologySchool of MedicineTurgut Ozal University Beştepeler Mh.Alparslan TürkeşCd No5706560 EmekAnkaraTurkey Email: muberranamli@ 123456hotmail.com

Article

Other ID: Int-J-Fertil-Steril-11-1

DOI: 10.22074/ijfs.2016.5144

PMC ID: 5215705

PubMed ID: 28367298

SO-VID: 65f36769-1c40-459e-9d2b-3d1ba6a44edd

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 9 November 2015

Date accepted : 10 September 2016

Custom metadata

Citation İltemir Duvan Z, Namlı Kalem M, Onaran Y, Aktepe Keskin E, Ayrım A, Pekel A, Kafalı H, Turhan N. The effect of coasting on intracytoplasmic sperm injection outcome in antagonist and agonist cycle. Int J Fertil Steril. 2017; 11(1): 1-6.

Keywords: ovarian hyperstimulation syndrome,gnrh agonist,gnrh antagonist

Data availability:

Keywords: ovarian hyperstimulation syndrome, gnrh agonist, gnrh antagonist