From The Cochrane Library, Issue 3, 2003. Oxford: Update Software Ltd. All rights reserved.

"Coasting" (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome (Cochrane Review)

D'Angelo A, Amso N


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A substantive amendment to this systematic review was last made on 11 May 2002. Cochrane reviews are regularly checked and updated if necessary.

Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Its reported incidence varies from 1% to 10% of in vitro fertilization (IVF) cycles. The factors leading to this syndrome have not been completely explained. It seems likely that the release of vasoactive substances, secreted by the ovaries under human chorionic gonadotropin (hCG) stimulation plays a key role in triggering this syndrome. The hallmark of this condition, is a massive shift of fluid from the intra-vascular compartment to the third space resulting in profound intra-vascular depletion and hemoconcentration.

Objectives: The objective of this review is to assess the effect of "coasting" (withholding gonadotrophins) as a preventative strategy in the management of OHSS following superovulation in assisted reproduction treatment on the incidence of all clinical grades of OHSS, in comparison with "early unilateral follicular aspiration (EUFA)" or other interventions.

Search strategy: Publications in the literature that described randomised controlled trials (RCTs) in which "coasting" was used as a preventative strategy to OHSS were included. The Cochrane Menstrual Disorders and Subfertility Review Group specialised register of controlled trials was searched. In addition, MEDLINE (PUBMED) 1985 to 2002, EMBASE (1985 to 2001), CINHAL (1985 to 2001) and National Research Register were also searched.

Selection criteria: Randomised controlled trials (RCTs) in which coasting was used as a preventative strategy to OHSS were included.

Data collection and analysis: Two reviewers selected trials and extracted data independently. Disagreements were resolved by discussion. Additional information on the trial methodology or data were requested by writing twice to the corresponding authors directly. The interventions compared were "coasting" versus "early unilateral follicular aspiration (EUFA)" or no "coasting" or other interventions. Statistical analysis was performed in accordance with the Cochrane Menstrual Disorders and Subfertility Group guidelines.

Main results: This review identified thirteen studies but only one trial met our inclusion criteria. There was no difference in the incidence of moderate and severe OHSS (n = 30, OR 0.76, 95% CI 0.18, 3.24)and in the clinical pregnancy rate (n = 30, OR 0.75, 95% CI 0.17, 3.33) between the groups.

Reviewers' conclusions: There is a lack of randomised controlled trials for where coasting is compared with no coasting or other interventions such as embryo freezing or intra-venous albumin infusion for prevention of OHSS. There is insufficient evidence to determine if coasting is an effective strategy for preventing OHSS.

Citation: D'Angelo A, Amso N. "Coasting" (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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File Reference: AB002811.htm