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Preimplantation Genetics Diagnosis

Prolonged Coasting

Sperm Chromatin Structure Assay

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Prolonged Coasting

The single most serious complication that an IVF patient faces, apart from multiple pregnancy, is the risk of becoming seriously ill after being stimulated with injectable fertility medications. This condition is known as Ovarian Hyperstimulation Syndrome (OHSS) and reports suggest that 1 to 2% of patients who receive these medications may develop signs of hemoconcentration, weight gain, severe abdominal distension, ovarian enlargement and in severe cases even renal failure. The exact cause of this syndrome is still incompletely understood, although it is well known that the administration of Human Chorionic Gonadotropin (HCG) is the precipitating event, which sets in motion, the symptoms mentioned above and that OHSS is made worse by pregnancy! When there are more than 20 follicles developing and the estradiol level rises above 4000 pg/ml then there is a risk of moderate OHSS and with more than 30 follicles and estradiol greater than 6000 pg/ml there is an 80% chance of developing severe OHSS. In the past, the only way of avoiding severe OHSS was to withhold the administration of the HCG and cancel the IVF cycle.

The patients most likely to develop OHSS are patients with menstrual cycles longer than 30 days or patients with irregular ovulation and menstruation. Age is also a factor, but OHSS can occur in patients over 40 years if more than 20 follicles are produced. We can therefore predict which patients are most likely to develop hyperstimulation based on menstrual history and we can also identify early during stimulation, which patients are producing more than 20 follicles. "Prolonged Coasting" is a simple procedure whereby the fertility medication is stopped at a very specific time, in patients that are at risk for OHSS. The correct time to discontinue the fertility medication is when approximately 30% of the follicles have reached 15 or 16 millimeters in diameter. The estradiol levels should be followed daily thereafter and they will continue to rise and when the estradiol level falls below 3000 pg/ml it is safe to administer HCG and proceed to egg retrieval.

Embryo quality after coasting is better than the quality seen in non coasted patients and the pregnancy outcome in patients who require coasting is excellent. It is important to restrict fluid intake to one liter of a sports drink like Gatorade per day for approximately 10 days after the egg retrieval.

If you think that you are a high responder or have menstrual cycles that are irregular, make sure that your doctor is familiar with "prolonged coasting" it may prevent a cancelled cycle and also avoid causing ovarian hyperstimulation syndrome.