Overenthusiastic treatment of infertility by budding gynecologist leading to moderate OHSS

Authors

  • Krishna Dahiya Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Pushpa Dahiya Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Kriti Agarwal Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Shaveta Jain Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20171456

Keywords:

Infertility, Moderate, Ovarian hyperstimulation syndrome

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of luteal phase or early pregnancy, occurring in up to 5% of women undergoing in vitro fertilization (IVF) or intrauterine insemination (IUI) procedures. A 19-year-old nulligravida married for six months presented with complaint of lower abdominal pain and lump abdomen for three days. Ovulation induction was started by a private practitioner with Clomiphene citrate (50mg OD, day3 to day 7 of menstrual cycle) followed by Human Menopausal Gonadotropin (HMG) on day10, 11, 12 and Human Chorionic Gonadotropin(HCG) on day 15 of the same cycle. Her symptoms started 14 days following injection of HCG. Abdominal examination demonstrated pelvic abdominal mass up to the level of umbilicus corresponding to 24 weeks’ size, tense, non-tender, mobile and of cystic consistency. Ultrasonograph of abdomen revealed uterus of normal size, endometrial thickness-20mm, right ovary of size 81x95x119mm with multiple cysts and left ovary of size 65x61x66mm with mild ascites. She was managed conservatively with bed rest, abdominal girth measurement, oral analgesics, intake output charting with plenty oral fluids and gentle leg exercises. Within two weeks of admission, pain was relieved and serial hematological and biochemical parameters remained normal. Repeat ultrasonography confirmed the presence of intrauterine live pregnancy and she was discharged. All gynecologists must know when, how and where to treat cases of infertility in order to prevent OHSS and its complications like renal failure, ARDS,thromboembolism,ovarian torsion and intra peritoneal hemorrhage.

References

Neulen J, Yan Z, Raczek S, Weindel K, Keck C, Weich HA, et al. Human chorionic gonadotropin-dependent expression of vascular endothelial growth factor/vascular permeability factor in human granulosa cells: importance in ovarian hyperstimulation syndrome. J Clin Endocrinol Metab. 1995;80:1967-71.

Yildizhan R, Adali E, Kolusari A, Kurdoglu M, Ozgokce C, Adali F. Ovarian Hyperstimulation Syndrome with pleural effusion: a case report. Cases J. 2008;1:323.

Marthur R, Kailasam C, Jenkins J. Review of the evidence base strategies to prevent ovarian hyperstimulation syndrome. Hum Fertil. 2007;10:75-85.

Geva E, Laffe RE. Role of vascular endothelial growth factor in ovarian physiology and pathology. Fertil Steril. 2007;74:429-38.

Haning RV, Austin CW, Carlson IH, Kuzma DL, Shapiro SS, Zweibel WJ. Plasma estradiol is superior to ultrasound and urinary estriol glucronide as a predictor of ovarian hyperstimulation during induction of ovulation with menotropins. Fertil Steril. 1983;40(1):31-6.

Smits G, Olatunbosun O, Delbaere A. Ovarian hyperstimulation syndrome due to a mutation in the follicle stimulating hormonereceptor. N Eng J Med. 2003;349:760-6.

Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Sertil. 1992;58:249-61.

Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000;73:901-7.

Elchalal U, Schenker JG. The pathophysiology of ovarian hyperstimulation syndrome- views and ideas. Hum Reprod. 1997;12:1129-37.

Smisha S and Sridev B. Case report on spontaneous ovarian hyperstimulation syndrome following natural conception and associated with primary hypothyroidism. J Hum Reprod Sci. 2013;6(2):158-61.

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Published

2017-03-30

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Section

Case Reports