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

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.