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Human Reproduction, Vol. 18, No. 5, 937-940, May 2003
© 2003 European Society of Human Reproduction and Embryology

Coasting—what is the best formula?

O. Levinsohn-Tavor, S. Friedler, M. Schachter, A. Raziel, D. Strassburger and R. Ron-El1

IVF and Infertility Unit, Department of Obstetrics and Gynecology, Assaf-Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

1 To whom correspondence should be addressed. rronel{at}asaf.health.gov.il

Coasting is a method to decrease the incidence of ovarian hyperstimulation syndrome (OHSS), which involves withdrawing exogenous gonadotrophins until the serum estradiol (E2) level decreases. The application of this strategy, as it appears in the literature, has been variable, with heterogeneous criteria for initiating and ending the coasting process and as a result, reports of efficacy are inconsistent. In attempt to establish a recommended protocol for coasting we reviewed and analysed 10 relevant studies, found by a Medline search. Based on the data collected, coasting should be initiated when the serum E2 concentration exceeds 3000 pg/ml, but not unless the leading follicles reach a diameter of 15–18 mm. Its duration should be limited to <4 days, thus, preventing the decrease in implantation and pregnancy rates that occur after longer periods of coasting. Administration of hCG should be withheld until serum E2 falls below 3000 pg/ml. Based on the published data, these suggested guidelines result in an acceptably low incidence of severe OHSS (<2%) and provide satisfactory fertilization and pregnancy rates (55–71% and 36.5–63% respectively). A multicentre randomized prospective study would help to confirm the effectiveness of this approach.

Key words: coasting/guidelines/IVF/ovarian hyperstimulation syndrome


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