Effect of coasting on cycle outcome during in vitro fertilization/intracytoplasmic sperm injection cycles in hyper-responders.

OBJECTIVE: To investigate the effect of coasting on IVF outcome in GnRH agonist cycles.

DESIGN: Retrospective analysis.

SETTING: Private IVF center.

PATIENT(S): Infertile couples undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment (normal responders [control], hyper-responders [coasting] groups).

INTERVENTION(S): Coasting to reduce the risk of ovarian hyperstimulation syndrome (OHSS) among hyper-responders.

MAIN OUTCOME MEASURE(S): Stimulation, embryology parameters, and pregnancy rate (PR).

RESULT(S): The average length of coasting was 2.2 days. Age and baseline FSH were comparable to control cycles. There were more follicles and oocytes in the coasting group, but the number of fertilized oocytes and embryos transferred were similar. Implantation rate (22.4% vs. 13.9%) was higher in the control group but the PRs were comparable (45.1% vs. 38.5%). Within the coasting group, baseline, stimulation, and embryology parameters were comparable between successful and unsuccessful cycles. Pregnancy rates were comparable after 1, 2, and 3 or more days of coasting (36.3% vs. 38.4% vs. 40%). Pregnancy rates were also comparable (28.5% vs. 35.7% vs. 44.4%) when groups were compared based on change in E2 (<25%, 25%-50%, >50%).

CONCLUSION(S): Coasting for 3 days can be used successfully in the management of the hyper-responding patients during IVF.