Short coasting of 1 or 2 days by withholding both gonadotropins and gonadotropin-releasing hormone agonist prevents ovarian hyperstimulation syndrome without compromising the outcome

Fertil Steril. 2008 Dec;90(6):2172-8. doi: 10.1016/j.fertnstert.2007.10.033. Epub 2008 Apr 25.


Objective: To evaluate the effect of short coasting, by withdrawing both gonadotropins and gonadotropin-releasing hormone (GnRH) agonist, on the prevention of severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome.

Design: Retrospective study.

Setting: Large urban medical center.

Patient(s): Forty-four women who had been coasted during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF).

Intervention(s): When >or=20 follicles >15 mm with serum estradiol (E(2)) level of 4000 pg/mL were detected, both gonadotropins and GnRH agonist were withheld for 1 to 2 days.

Main outcome measure(s): Changes of serum E(2) levels, number of oocytes retrieved, pregnancy rate.

Result(s): The mean serum E(2) level fell from 7915 pg/mL at the onset of coasting to 3908 pg/mL on the day of human chorionic gonadotropin (hCG) administration. The mean number of oocytes retrieved and fertilization rate were 17.2% and 75.0%, respectively. Eighteen patients became pregnant (43.9%), and the implantation rate was 12.7%. Twenty-eight patients were coasted for 1 day, and 13 were coasted for 2 days. The mean decrease rate of serum E(2) level was 45.3% in 1-day coasting and 26.4% (first day) and 75.3% (second day) in 2-day coasting. The pregnancy outcome was similar between both groups. After coasting, three mild and two severe cases of OHSS occurred.

Conclusion(s): Coasting for 1 or 2 days can be used successfully to prevent OHSS without compromising IVF cycle outcome.

MeSH terms

  • Adult
  • Drug Administration Schedule
  • Embryo Transfer
  • Estradiol / blood
  • Female
  • Fertility Agents, Female / administration & dosage*
  • Fertility Agents, Female / adverse effects
  • Fertilization in Vitro*
  • Gonadotropin-Releasing Hormone / agonists*
  • Gonadotropins / administration & dosage*
  • Gonadotropins / adverse effects
  • Humans
  • Infertility / metabolism
  • Infertility / therapy*
  • Oocyte Retrieval
  • Ovarian Hyperstimulation Syndrome / etiology
  • Ovarian Hyperstimulation Syndrome / prevention & control*
  • Ovulation Induction / adverse effects
  • Ovulation Induction / methods*
  • Pregnancy
  • Pregnancy Rate
  • Retrospective Studies
  • Treatment Outcome


  • Fertility Agents, Female
  • Gonadotropins
  • Gonadotropin-Releasing Hormone
  • Estradiol