Ovarian Hyperstimulation Syndrome Following In-Vitro Fertilization: A Case Report

Abstract

A 34-year-old gravida 0, para 0 female with a history of in-vitro fertilization (IVF) treatment for infertility and polycystic ovarian syndrome (PCOS) presented to the emergency department (ED) with worsening abdominal pain and distention. Seven days prior, she underwent her second egg retrieval procedure. Four days post-procedure, she initially sought care in the ED, where the ultrasound revealed fluid accumulation. She opted for observation over transvaginal fluid drainage. Despite this, her symptoms progressed, prompting her to return to the ED. On physical examination, the patient exhibited abdominal distension and tenderness. Bedside ultrasound revealed free fluid in the pelvis and Morrison's pouch. Laboratory findings included leukocytosis (WBC 13.1 × 10^9/L), hyponatremia (Na 131 mmol/L), elevated C-reactive protein (19.1 mg/L), and hypoalbuminemia (3.3 g/dL). Imaging, including CT and transvaginal ultrasound, demonstrated large ascites, bilateral ovarian enlargement with theca lutein cysts, small pleural effusions, and findings consistent with ovarian hyperstimulation syndrome (OHSS). The patient underwent ultrasound-guided paracentesis in the ED, yielding 2000 mL of straw-colored fluid, which resulted in significant symptomatic relief. She was admitted for further management of moderate to severe OHSS, including fluid resuscitation and thromboprophylaxis. This case highlights the importance of early recognition and multidisciplinary management of OHSS to mitigate morbidity in patients undergoing assisted reproductive technologies.