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Thursday, January 26, 2012

Case of Unidentified Polycystic Ovarian Syndrome complicated in Ovarian Hyper-Stimulation Syndrome (OHSS)

Subject - Ovum donor Age 20, unknown case of Polycystic Ovarian Syndrome (PCOS) on COH (Controlled Ovarian Hyper-stimulation) for Ovum Donationwas put on Down Regulation Long Protocol. On serial ultrasound, she developed more than 15 follicles in each ovary. HCG 10,000 I.U. was given i.m. when follicles reached 18-20 mm. On the day of ovum retrieval, when right ovary was aspirated, most of the content of aspirated follicular fluid contained blood. On microscopic observation, only 2 immature-looking oocytes were obtained. Left ovary aspiration was very difficult because of the thickening of the capsule. With much difficulty, most of the follicle contents were aspirated. However, out of 14-15 follicles puncture, only 1 deformed oocyte was obtained. The donor was put on progesterone injection (i.m). After 5 days of ovum retrieval, she developed signs of Ovarian Hyper-Stimulation Syndrome (OHSS)with pain in the lower abdomen. She was treated by anti-spasmotics and was asked for bed rest. After 2 days, she developed dyspnoea with pain in the lower abdomen. On examination, she was found to be hypotensive with B.P. 80/40 and USG showed huge ascitis on both sides of abdomen and she was admitted in an Intensive Care Unit (ICU). Her electrolytes levels were maintained by intravenous fluid administration. Intravenous albumin (100 ml) was also infused slowly 4 hourly. She was also put on antibiotics, anti-coagulants and daily progesterone injections were continued. She was planned for paracentesis immediately, but due to some unavoidable circumstances, the paracentesis was delayed for 2 days, when she had already developed hydrothorax. Again, intravenous albumin (100 ml) was infused slowly. At this moment, patient developed breathing difficulties and her oxygen saturation was decreasing (<80 mm Hg). Her Chest X-Ray showed bilateral pleural effusion. Patient was about to put on ventilator when paracentesis of both side was done. About 1.5 litres of fluid was drained from both side on 2 occasions. Intravenous albumin (100 ml) infusion was repeated third time. The next day, patient’s vitals were normalized and the patient was discharged from the ICU.

Dr. Uma Shrivastava
Founder Director
Infertility Centre