A Case of Chinese Medicine Intervention on Pregnancy Complicated with Severe Ovarian Hyperstimulation Syndrome

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

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Prorenin and active renin concentrations in plasma and ascites during severe ovarian hyperstimulation syndrome

Human Reproduction ◽

10.1093/humrep/12.2.236 ◽

1997 ◽

Vol 12 (2) ◽

pp. 236-240 ◽

Cited By ~ 16

Author(s):

A. Delbaere ◽

P. J. Bergmann ◽

C. Gervy-Decoster ◽

M. Camus ◽

V. de Maertelaer ◽

...

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Active Renin ◽

Severe Ovarian Hyperstimulation Syndrome

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CASE REPORT: Severe ovarian hyperstimulation syndrome, selective embryo reduction and heterotopic pregnancy

Human Reproduction ◽

10.1093/oxfordjournals.humrep.a138251 ◽

1993 ◽

Vol 8 (8) ◽

pp. 1329-1331 ◽

Cited By ~ 3

Author(s):

Lawrence Mascarenhas ◽

Brian Eliot

Keyword(s):

Case Report ◽

Ovarian Hyperstimulation Syndrome ◽

Heterotopic Pregnancy ◽

Ovarian Hyperstimulation ◽

Selective Embryo Reduction ◽

Severe Ovarian Hyperstimulation Syndrome

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Prediction of severe ovarian hyperstimulation syndrome in women undergoing in vitro fertilization using estradiol levels, collected ova, and number of follicles

Journal of International Medical Research ◽

10.1177/0300060520945551 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094555

Author(s):

Ivan Madrazo ◽

Monserrat Fabiola Vélez ◽

Josue Jonathan Hidalgo ◽

Ginna Ortiz ◽

Juan José Suárez ◽

...

Keyword(s):

Ovarian Hyperstimulation Syndrome ◽

Characteristic Curve ◽

Antral Follicle ◽

Antral Follicle Count ◽

Ovarian Hyperstimulation ◽

Vitro Fertilization ◽

American Society ◽

Severe Ovarian Hyperstimulation Syndrome ◽

Severe Ohss

Objective Our objective was to determine whether estradiol (E2) levels (Day 3 and fold change to Day 10), antral follicle count (AFC), and number of ova collected could predict ovarian hyperstimulation syndrome (OHSS) and culdocentesis intervention. Methods We conducted a retrospective review of patient charts between January 2008 and December 2017. OHSS was defined using American Society for Reproductive Medicine criteria. Predictability was evaluated by measuring the area under the receiver operating characteristic curve (AUC). Results The cohort included 319 women (166 controls, 153 OHSS, of whom 54 had severe OHSS). The OHSS group had higher E2Day 3 (249 ± 177 vs. 150 ± 230 ng/L), E2FoldChange (32.2 ± 29.1 vs. 20.1 ± 23.8), AFC (18.2 ± 9.1 vs. 11.6 ± 8.3), and number of ova collected (21.1 ± 9.0 vs. 10.1 ± 6.5). E2Day 3 (AUC = 0.76, 95%CI: 0.71–0.82), E2FoldChange (AUC = 0.71, 95%CI: 0.65–0.77), AFC (AUC = 0.75, 95%CI: 0.70–0.81), and number of ova collected (AUC = 0.85, 95%CI: 0.81–0.89) were predictive for OHSS. All variables were predictive for culdocentesis intervention (E2Day 3: AUC = 0.63, 95%CI: 0.55–0.70; E2FoldChange: AUC = 0.63, 95%CI: 0.55–0.71; AFC: AUC = 0.74, 95%CI: 0.68–0.80; number of ova collected: AUC = 0.80, 95%CI: 0.75–0.85). Conclusions Day 3 E2 levels and number of ova collected predict patients who could develop OHSS and may require culdocentesis.

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