如何评价Coasting预防卵巢过度刺激综合征的作用

How to evaluate efficacy of coasting in prevention of ovarian hyperstimulation syndrome

控制性促排卵（CoH）最严重和潜在致命的并发症是重度卵巢过度刺激综合征（OHsS）。在体外受精-胚胎移植（IVF—ET）中有8．4％～23．39／6患者并发0HSS，其中重度0HSS发生率为0．1％～0．2％。目前0HSS发生病因尚不十分清楚，可能的原因是颗粒细胞分泌大量导致0HSS发生的类固醇激素及血管活性物质。临床上常采用取消周期、冻胚移植、取卵日给予白蛋白、单侧卵巢卵泡抽吸术等方法，但疗效不佳，且患者经济上和精神上均难以接受。随着对0HSS发病机制研究的深入，0HSS的预防亦有所进展，尤其是Coasting疗法对预防oHSS起着重要的作用。

Ovarian hyperstimulation syndrome （OHSS） is a serious complication following controlled ovarian hyperstimulation （COH） for in vitro fertilization and embryo transfer （IVF-ET）. Several methods have been tried to prevent the syndrome, since little can be done to change the course of events once the syndrome develops. These methods included administration of lower dose of gonadotropin, unilateral ovarian follicular aspiration, usage of human albumin solution during oocyte retrieval, cryopreservation of all embryos and coasting. Withholding gonadotrophin administration and postponing hCG injection, termed coasting, has been applied in ovulation induction cycles to prevent excessive response. It appears the most popular method used to prevent OHSS. A long coasting period （〉3 days） has a negative effect on the number of oocytes and tends to reduce the quality of oocytes.