{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T02:36:37Z","timestamp":1768271797853,"version":"3.49.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Ovarian hyperstimulation syndrome (OHSS) can be a severe and potentially life-threatening complication of ovarian stimulation for IVF. Coasting or withholding gonadotrophin stimulation relies on frequent estimation of serum oestradiol to identify patients at risk. A modified coasting protocol was developed in which identification of patients at risk of severe OHSS was based on ultrasound monitoring. Serum oestradiol concentrations were measured only in patients with &gt;20 follicles on ultrasound (high risk). If serum oestradiol concentrations were &lt;3000 pmol\/l, the gonadotrophin dose was maintained; if concentrations were \u22653000 pmol\/l but &lt;13200 pmol\/l and \u226525% of the follicles had a diameter of \u226513 mm, the gonadotrophin dose was halved; and if serum oestradiol concentrations were \u226513 200 pmol\/l and \u226525% of the follicles had a diameter of \u226515 mm, patients were coasted. In the latter group, human chorionic gonadotrophin (HCG) 10000 IU was administered when at least three follicles had a diameter of \u226518 mm and serum oestradiol concentrations were &lt;10000 pmol\/l. Over a 10 month period, serum oestradiol concentrations were measured in 123 out of 580 cycles (24%) and in 50 cycles, gonadotrophins were withheld. Overall, moderate OHSS occurred in three patients (0.7%) and severe OHSS in one patient (0.2%). The pregnancy rates in the cycles where the gonadotrophin dose was reduced or withheld were 39.6 and 40% per cycle respectively; corresponding implantation rates were 30.7 and 25.6%. It is concluded that the modified coasting strategy is associated with a low risk of moderate and severe OHSS to a minimum without compromising pregnancy rates. Identification of patients at risk by ultrasound reduces the number of serum oestradiol measurements and thus inconvenience to patients as well as costs and workload.<\/jats:p>","DOI":"10.1093\/humrep\/16.1.24","type":"journal-article","created":{"date-parts":[[2002,7,26]],"date-time":"2002-07-26T22:50:44Z","timestamp":1027723844000},"page":"24-30","source":"Crossref","is-referenced-by-count":64,"title":["Prevention of severe ovarian hyperstimulation syndrome in IVF with or without ICSI and embryo transfer: a modified `coasting' strategy based on ultrasound for identification of high-risk patients"],"prefix":"10.1093","volume":"16","author":[{"given":"T.","family":"Al-Shawaf","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Zosmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Tozer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Panay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.M.","family":"Lower","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.G.","family":"Grudzinskas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2001,1,1]]},"reference":[{"key":"2019070202160328600_ABOULGHAR-ETAL-1992","unstructured":"Aboulghar, M.A., Mansour, R.T., Serour, G.I. et al. (1992) Follicular aspiration does not protect against the development of ovarian hyperstimulation syndrome. J. Assist. Reprod. Genet., 9, 238\u2013243."},{"key":"2019070202160328600_AGRAWAL-ETAL-1999","unstructured":"Agrawal, R., Tan, S.L., Wild, S. et al. (1999) Serum vascular endothelial growth factor concentrations in in vitro fertilization cycles predict the risk of ovarian hyperstimulation syndrome. Fertil. Steril., 71, 287\u2013293."},{"key":"2019070202160328600_AMIT-ETAL-1993","doi-asserted-by":"crossref","unstructured":"Amit, A., Yaron, Y., Yovel, I. et al. (1993) Repeated aspiration of ovarian follicles and early corpus luteum cysts in an in-vitro fertilization programme reduces the risk of ovarian hyperstimulation syndrome in high responders. Hum. Reprod., 8, 1184\u20131186.","DOI":"10.1093\/oxfordjournals.humrep.a138225"},{"key":"2019070202160328600_AMSO-ETAL-1990","unstructured":"Amso, N.N., Ahuja, K.K., Morris, N. and Shaw, R.W. (1990) The management of predicted ovarian hyperstimulation involving gonadotrophin-releasing hormone analogue with elective cryopreservation of all pre-embryos. Fertil. Steril., 53, 1087\u20131090."},{"key":"2019070202160328600_ASCH-ETAL-1991","doi-asserted-by":"crossref","unstructured":"Asch, R.H., Huey-Po, L., Balmaceda, J.P. et al. (1991) Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups. Hum. Reprod., 10, 1395\u20131399.","DOI":"10.1093\/oxfordjournals.humrep.a137276"},{"key":"2019070202160328600_ASCH-ETAL-1993","unstructured":"Asch, R.H., Ivery, G., Goldsman, M. et al. (1993) The use of intravenous albumin in patients at high risk for severe ovarian hyperstimulation syndrome. Hum. Reprod., 8, 1015\u20131020."},{"key":"2019070202160328600_BALASCH-ETAL-1991","unstructured":"Balasch, J., Arroyo, V., Carmona, F. et al. (1991) Severe ovarian hyperstimulation syndrome: role of peripheral vasodilatation. Fertil. 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