International Journal of Infertility & Fetal Medicine

Register      Login

VOLUME 10 , ISSUE 2 ( May-August, 2019 ) > List of Articles

CASE REPORT

Severe Ovarian Hyperstimulation Syndrome in a Patient of Polycystic Ovarian Syndrome, Necessitating Paracentesis, with Successful Pregnancy Outcome: A Case Report

Swati Agrawal, Kiran Aggarwal, Manvi Dua, Juhi Agarwal

Keywords : Assisted reproductive techniques, Cabergoline, Case report, Complication, Ovarian hyperstimulation syndrome, Paracentesis, Polycystic ovarian syndrome, Pregnancy

Citation Information : Agrawal S, Aggarwal K, Dua M, Agarwal J. Severe Ovarian Hyperstimulation Syndrome in a Patient of Polycystic Ovarian Syndrome, Necessitating Paracentesis, with Successful Pregnancy Outcome: A Case Report. Int J Infertil Fetal Med 2019; 10 (2):34-36.

DOI: 10.5005/jp-journals-10016-1186

License: CC BY-NC 4.0

Published Online: 01-08-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: Severe ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation which requires a multipronged management to achieve a favorable outcome. Case description: A 24-year-old infertile lady with polycystic ovarian syndrome (PCOS) presented with the complaints of vomiting, abdominal pain, and abdominal distension following ovulation induction with follicular-stimulating hormone. Ultrasound suggested bilateral enlarged ovaries with moderate free fluid in the Pouch of Douglas. A diagnosis of OHSS was made, and oral cabergoline with prophylactic anticoagulation was initiated along with supportive management. However, the patient continued to deteriorate and was shifted to intensive care unit and started on human albumin infusion. Despite all measures, the patient developed tachypnea with tense ascites and oliguria which necessitated ultrasound-guided abdominal paracentesis twice. The patient started improving following paracentesis, was diagnosed to have quadruplet pregnancy, and discharged in stable condition. Two of four embryos did not thrive, and eventually, the patient delivered two healthy babies by cesarean section. Conclusion: Management of severe OHSS requires multimodality treatment. Surgical intervention in the form of paracentesis should be strongly considered in patients with tense ascites, leading to respiratory compromise and oliguria, which is refractory to medical management. Clinical significance: The case report highlights the need for extreme caution during controlled ovarian hyperstimulation in patients with PCOS. The case also aims to guide in the management of a case of severe OHSS, which may require a combination of therapies including paracentesis for a favorable outcome.


PDF Share
  1. Steward RG, Lan L, Shah AA, et al. Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: an analysis of 256,381 in vitro fertilization cycles. Fertil Steril 2014;101(4):967–973. DOI: 10.1016/j.fertnstert.2013.12.026.
  2. Luke B, Brown MB, Morbeck DE, et al. Factors associated with ovarian hyperstimulation syndrome (OHSS) and its effect on assisted reproductive technology (ART) treatment and outcome. Fertil Steril 2010;94(4):1399–1404. DOI: 10.1016/j.fertnstert.2009.05.092.
  3. Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Practice committee of the american society for reproductive medicine. Fertil Steril 2016;106(7):1634–1647. DOI: 10.1016/j.fertnstert.2016.08.048.
  4. Jayaprakasan K, Chan Y, Islam R, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril 2012;98(3):657–663. DOI: 10.1016/j.fertnstert.2012.05.042.
  5. Fischer D, Reisenbüchler C, Rösner S, et al. Avoiding OHSS: controlled ovarian low-dose stimulation in women with PCOS. Geburtshilfe Frauenheilkd 2016;76(6):718–726. DOI: 10.1055/s-0042-100206.
  6. Kahnberg A, Enskog A, Br€annstrom M, et al. Prediction of ovarian hyperstimulation syndrome in women undergoing in vitro fertilization. Acta Obstet Gynecol Scand 2009;88(12):1373–1381. DOI: 10.3109/00016340903287482.
  7. Palomba S, Falbo A, La Sala GB. Effects of metformin in women with polycystic ovary syndrome treated with gonadotrophins for in vitro fertilisation and intracytoplasmic sperm injection cycles: a systematic review and meta-analysis of randomised controlled trials. BJOG 2013;120(3):267–276. DOI: 10.1111/1471-0528.12070.
  8. The Management of Ovarian Hyperstimulation Syndrome. Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 5. 2016.
  9. Rova K, Passmark H, Lindqvist PG. Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles. Fertil Steril 2012;97(1):95–100. DOI: 10.1016/j.fertnstert.2011.10.038.
  10. Morris RS, Miller C, Jacobs L, et al. Conservative management of ovarian hyperstimulation syndrome. J Reprod Med 1995;40(10):711–714.
  11. Makino H, Furui T, Shiga T, et al. Management of ovarian hyperstimulation syndrome with abdominal compartment syndrome, based on intravesical pressure measurement. Reprod Med Biol 2016;16(1):72–76. DOI: 10.1002/rmb2.12005.
  12. Agarwal N, Ghosh S, Bathwal S, et al. Large-volume paracentesis, up to 27 L, with adjuvant Vaginal cabergoline in the case of severe ovarian hyperstimulation syndrome with successful pregnancy outcome: a case report. J Hum Reprod Sci 2017;10(3):235–237. DOI: 10.4103/jhrs.JHRS_13_17.
  13. Dawood AS, Omar MK. Continuous vs intermittent paracentesis in severe ovarian hyperstimulation syndrome: a multicenter randomized clinical trial. J Reprod Biol Endocrinol 2017;1(2): 23–28.
  14. Abuzeid M, Warda H, Joseph S, et al. Outpatient management of severe ovarian hyperstimulation syndrome (OHSS) with placement of pigtail catheter. Facts Views Vis Obgyn 2014;6(1):31–37.
  15. Papanikolaou EG, Tournaye H, Verpoest W, et al. Early and late ovarian hyperstrimulation syndrome: early pregnancy outcome and profile. Hum Reprod 2005;20(3):636–641. DOI: 10.1093/humrep/deh638.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.