| Prevention of severe ovarian hyperstimulation syndrome in IVF with or without ICSI and embryo transfer: a modified 'coasting' strategy based on ultrasound for identification of high-risk patients. | |
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MedLine Citation:
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PMID: 11139531 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Ovarian hyperstimulation syndrome (OHSS) can be a severe and potentially life-threatening complication of ovarian stimulation for IVF. Coasting or withholding gonadotrophin stimulation relies on frequent estimation of serum oestradiol to identify patients at risk. A modified coasting protocol was developed in which identification of patients at risk of severe OHSS was based on ultrasound monitoring. Serum oestradiol concentrations were measured only in patients with >20 follicles on ultrasound (high risk). If serum oestradiol concentrations were <3000 pmol/l, the gonadotrophin dose was maintained; if concentrations were >/=3000 pmol/l but <13200 pmol/l and >/=25% of the follicles had a diameter of >/=13 mm, the gonadotrophin dose was halved; and if serum oestradiol concentrations were >/=13 200 pmol/l and >/=25% of the follicles had a diameter of >/=15 mm, patients were coasted. In the latter group, human chorionic gonadotrophin (HCG) 10000 IU was administered when at least three follicles had a diameter of >/=18 mm and serum oestradiol concentrations were <10000 pmol/l. Over a 10 month period, serum oestradiol concentrations were measured in 123 out of 580 cycles (24%) and in 50 cycles, gonadotrophins were withheld. Overall, moderate OHSS occurred in three patients (0.7%) and severe OHSS in one patient (0.2%). The pregnancy rates in the cycles where the gonadotrophin dose was reduced or withheld were 39.6 and 40% per cycle respectively; corresponding implantation rates were 30.7 and 25.6%. It is concluded that the modified coasting strategy is associated with a low risk of moderate and severe OHSS to a minimum without compromising pregnancy rates. Identification of patients at risk by ultrasound reduces the number of serum oestradiol measurements and thus inconvenience to patients as well as costs and workload. |
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Authors:
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T Al-Shawaf; A Zosmer; S Hussain; A Tozer; N Panay; C Wilson; A M Lower; J G Grudzinskas |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Human reproduction (Oxford, England) Volume: 16 ISSN: 0268-1161 ISO Abbreviation: Hum. Reprod. Publication Date: 2001 Jan |
Date Detail:
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Created Date: 2001-01-26 Completed Date: 2001-03-08 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8701199 Medline TA: Hum Reprod Country: England |
Other Details:
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Languages: eng Pagination: 24-30 Citation Subset: IM |
Affiliation:
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Fertility Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. talhayas@aol.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Chorionic Gonadotropin / administration & dosage Embryo Transfer Estradiol / blood Female Fertilization in Vitro / adverse effects Humans Male Ovarian Follicle / ultrasonography Ovarian Hyperstimulation Syndrome / prevention & control*, ultrasonography* Ovulation Induction / adverse effects Pregnancy Risk Factors Sperm Injections, Intracytoplasmic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Chorionic Gonadotropin; 50-28-2/Estradiol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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