TITLE:
Follicular Aspiration Is Superior to Coasting as Effective Prophylactic Procedure against Ovarian Hyperstimulation Syndrome
AUTHORS:
Walid Mohamed Elnagar, Huda Fathy Ebian
KEYWORDS:
Ovarian Hyperstimulation Syndrome, PCOS, Follicular Aspiration, Coasting Procedure
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.5,
May
22,
2019
ABSTRACT: Objectives: Evaluation of outcome follicular aspiration compared to coating procedure for
infertile women undergoing ICSI regarding frequency and severity of ovarian
hyperstimulation syndrome (OHSS). Patients & Methods: Infertile PCOS women
underwent controlled ovarian stimulation with luteal phase GnRH-agonist long
down-regulation protocol. Women developed serum E2 level > 4000
pg/ml and/or >20 follicles of ≥10 mm in diameter were randomly divided to
receive coasting strategy (Coasting group) or TVU-guided aspiration (Aspiration
group). When ≥3 follicles were ≥18 mm and serum E2 level was
and 10,000 IU was administered 36 h before oocyte
retrieval, and
ICSI was performed 72-hr thereafter and the frequency of moderate-to-severe
OHSS was determined. Results: 82 women developed criteria for categorization
and 21 women (25.6%) developed moderate-to-severe OHSS; 5 women of aspiration
and 16 of Coasting group; with
significantly (P = 0.005) lower frequency in aspiration group. Twenty women
developed ascites; 3 women had clinically detectable, while 17 women had US
detected ascites with significantly (P = 0.039) higher frequency among women that had coasting. All other
manifestations of OHSS were significantly lower with aspiration procedure. Both
coasting and aspiration therapy significantly reduced serum E2 and ovarian
diameter on day of hCG injection compared to estimates taken at time of
categorization. Conclusion: Coasting procedure prior to hCG injection could
decrease incidence of OHSS and lessens its manifestation. Follicular aspiration
provided more superior results and improved outcome of these women. Any of
these modalities could be provided to infertile high-risk women according to
the availability of experiences and patients’ selection.