Coasting at the end of stims
5 Replies
laura - May 16

Dear Doctor,
I am at the end FSH stims on my second IVF cycle. I stimed for 8 days. The next day I had an estradial of 3019 (on day 9), 10 follicals >16, 10 follicles <16. They let me coast with out (only 5 units of lupron) meds on day 9. On day 10 they FSH stimmed me again. My questions are:

Is this considered 9 or 10 days of stimutation?
Dose coasting an extra day help the follicles mature?
Do you ever do this?
thanks
laura

 

Dr Smith - May 16

That would be considered a 10-day stimulation, even though you didn't actually take the stimulation medication(s) each of the 10 days. "Coasting" slows down the folliclular development a little bit to make sure the eggs inside the follicles have enough time to mature (i.e. to let the eggs catch up). It also lowers the estrogen circulating in your body and may prevent hyperstimulation syndrome. Coasting is a common way to manage ovarian stimulation in young women and women with PCOS.

 

laura - May 16

Thank you Dr. Smith,
Today my esrtadial is 4840. Stim day 11. They are letting me coast another night. I have 10 follicals >16 and 10 folicals between 11-14. How many days for ideal stimmmulation ? At what estradial level is there more risk for hyperstimmulation?
Thanks soo much!!
laura

 

Dr Smith - May 16

The optimal stimulation is between 9 and 12 days with the average being about 10. However, coasting cycles can go a little longer without any bad effects. Women can experience hyperstimulation syndrome at any E2 level above 2000 pg/ml. However, the risk increases significantly with the E2 gets above 5000. You're almost there, that's why they decided to coast. You appear to be in good hands. Best of luck.

 

laura - May 23

Dear Dr. Smith,
This is my second IVF cycle. Is it normal for 2 cycles on the same meds be so different (I was given less follistem the second time) ?
2nd IVF stimmed for 14 days but coasted 5 of those days. Estradiol on stimm day 12 became too high at 6560 (for at least 24 hours, they checked the day befor and it was 4840 and the day after 5197). They coasted me for 2 more days for an estradiol of 4660 and triggered me. Even though I had 23 follicals, they retreaved only 7 eggs.
Did the high estrogen burn out the eggs? I do not have much hopem this cycle.

1 st IVF 9 days of stimmulation, highest esstradiol 2373, 18 eggs, 13 mature, the best 5 were transfered on day 3 (only two 8 cell). The rest did not make it to bast.

Thank you so much!

laura

 

Dr Smith - May 24

Coasting for more than 4 consecutive days is not recommended, so coasting for 5 days may have compromised the cycle (i.e. fewer eggs retreived). When the E2 exceeds 6000 pg/ml, reduced fertilization rates and diminished embryo quality is expected.

It is somewhat unusual to observe such a large difference in your ovarian response between cycles, particularly in view of the fact that they reduced your medication on the second cycle. However, this is biology we are dealing with and significant variation can be expected within any biological system, including ovarian stimulation. Hang in there and see what happens. Best of luck.

 

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