The effect of coasting on the outcome of intracytoplasmic sperm injection: comparable analysis of gnrh agonist and antagonist cycles

Abstract

Introduction: One of the preventive strategies in case of impeding ovarian hyperstimulation syndrome (OHSS) is coasting. The aim of this study was to compare the effect of coasting in high responder patients treated with gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist protocol for intracytoplasmic injection and embryo transfer. Materials and Methods: This retrospective study was conducted in the infertility unit in a private hospital. The study group included women who underwent an intra-cytoplasmic sperm injection (ICSI) cycle with a coasted period during ovulation induction from 2006 to 2013. The cycles outcome of cycles were compared between GnRH agonist (n=226) and GnRH antagonist (n=110) coasting cycles. Results: Women's age and other baseline characteristics of the groups were similar. Coasting was significantly more required in GnRH agonist cycles compared to GnRH antagonist cycles (11.8% vs. 4.5%, respectively, OR = 2.63, p < 0.001). Live birth rates after coasting were 41.5% in the GnRH agonist group and 40.9% in the GnRH antagonist group (p = 0.903). Moderate-severe OHSS occurred in 13 (5.7%) cases in the GnRH agonist group and three (2.7%) cases in the GnRH antagonist group (p = 0.343). In the GnRH agonist group, the longer duration of coasting (>= four days) was associated with the lowest live birth rate (27.2%), but it did not reach a statistical significance. Conclusions: Live birth and moderate/severe OHSS rates are similar in the GnRH agonist and the GnRH antagonist cycles with coasting. Despite the lack of statistical significance, >= four days of coasting is related to the lowest live birth rate through ICSI compared to < four days of coasting in the GnRH agonist cycles.