Published: 2022-08-29

A rare case of spontaneous ovarian hyperstimulation syndrome in a pregnant female managed conservatively

Shikhanshi ., Niranjan Chavan, Deepali Kapote, Ashwini Sakhalkar


Ovarian hyperstimulation syndrome (OHSS) is a rare syndrome, characterized by cystic enlargement of the ovaries and a fluid shift from the intravascular to the third space due to ovarian neo-angiogenesis and increased capillary permeability. It is generally iatrogenic, occurring due to administration of human chorionic gonadotrophin (hCG) during assisted reproductive techniques. Spontaneous form of OHSS is so rare that is easy to confuse the diagnosis of spontaneous OHSS with other causes. Only few cases have been reported in literature where OHSS was seen without prior stimulation from any exogenous hormones. Here we present a case of spontaneous OHSS in a 30-year-old Indian female who was 5 weeks pregnant. Since there was no history of hormone stimulation before/during this pregnancy, ovarian carcinoma instead of OHSS was thought to be the primary diagnosis. There was presence of breathlessness, ascites and bilateral ovarian masses with raised CA-125. A battery of tests and investigations, the diagnosis of moderate OHSS was made after excluding all other causes. The patient was managed conservatively and her symptoms improved with time. Ovarian hyperstimulation syndrome is generally suspected strongly in patients undergoing infertility treatment whenever there is 3rd space accumulation of fluid or increase in number of follicles in ovary. However, rarely spontaneous ovarian hyperstimulation syndrome can be considered as differential diagnosis in cases where no other causes can be found for presence of abdominal pain, nausea-vomiting, ascites, pleural effusion and enlargement of ovaries specially if the patient is pregnant. Due to increased vascular permeability in such cases along with extravascular loss of fluid, there is intravascular hypovolemia. If the diagnosis is missed, there may be risk of unnecessary interventions and morbidity in such patients. Strict monitoring of patient in hospital is required. In most cases of mild to moderate OHSS only conservative management is needed while in severe cases, intensive care unit (ICU) admission may be necessary.


Spontaneous ovarian hyperstimulation, OHSS, Ascites, Pleural effusion, Pregnancy

Full Text:



Chae HD, Park EJ, Kim SH, Kim CH, Kang BM, Chang YS. Ovarian hyperstimulation syndrome complicating a spontaneous singleton pregnancy: a case report. J Assist Reprod Genet. 2001;18(2):120-3.

Cardoso CG, Graca LM, Dias T, Clode N, Soares L. Spontaneous ovarian hyperstimulation and primary hypothyroidism with a conceived pregnancy. Obstet Gynecol. 1999;93(5):809-11.

Topdagi Yilmaz EP, Yapca OE, Topdagi YE, Kaya Topdagi S, Kumtepe Y. Spontaneous Ovarian Hyperstimulation Syndrome with FSH Receptor Gene Mutation: Two Rare Case Reports. Case Rep Obstet Gynecol. 2018;9294650.

Daelemans C., Smits G., De Maertelaer V., et al. Prediction of severity of symptoms in iatrogenic ovarian hyperstimulation syndrome by follicle-stimulating hormone receptor Ser680Asn polymorphism. J Clin Endocrinol Metab. 2004;89(12):6310-5.

The Management of Ovarian Hyperstimulation Syndrome (Green-top Guideline No. 5). Available at: Accessed on 12 May 2022.

Delbaere A, Smits G, De Leener A, Costagliola S, Vassart G. Understanding ovarian hyperstimulation syndrome. Endocrine J. 2005;26(3):285-9.