Publication:

Overenthusiastic treatment of infertility by budding gynecologist leading to moderate OHSS

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.