Ovarian hyperstimulation syndrome in an egg donor

Clinical History

A 25-year-old female suffering from abdominal pain and distension, nausea and vomiting after ovarian induction in order to donate eggs the day before, with no other relevant physical signs or symptoms or analytic alterations.

Imaging Findings

An abdominal, pelvic and transvaginal ultrasound performed by the on-call radiologist in the Emergency Department revealed an increase in the size of both ovaries (up to 9.5 cm), which were full of follicles, one of them in the left ovary with internal echoes suggestive of blood (haemorrhagic follicle) (Fig. 1). There was also perihepatic, subhepatic, perisplenic and pelvic ascites, as well as ascites in the pouch of Douglas (Fig. 2). The rest of the ultrasound examination showed no other alterations. Subsequently, given the symptoms, the history of ovarian stimulation and the ultrasound findings, the patient was diagnosed with ovarian hyperstimulation syndrome (OHSS).

Discussion

Ovarian hyperstimulation syndrome consists of the stimulation of the ovaries by exogenous gonadotropines, which enlarge and grow many follicles. This condition usually occurs in women undergoing fertilization treatments or egg donors, as it happened to be in this case, or more rarely, in spontaneous pregnancy [1, 2]. Even though in the majority of cases it has little clinical concern, OHSS may be a life-threatening condition in some cases [2]. In the latter, an excessive release of cytokines produces an increase of the vascular permeability that leads to the creation of third spaces (ascites or pleural effusion) associated with haemoconcentration [1, 2].
The symptoms of this entity are abdominal pain and distension, nausea, weight gain or vomiting if the disease becomes more serious, and dyspnoea or renal failure if it becomes still more severe [1, 2].
The diagnosis is made with a history of ovarian induction stimulation and the detection of enlarged ovaries with multiple follicles, usually by abdominal or transvaginal ultrasound, with ascites being a finding that can be present or not depending on the severity of this disease [2].
The aim of the treatment of the OHSS is to restore the circulating intravascular volumen, as well as to reduce the intraabdominal pressure by paracentesis if there is much ascites [1]. Depending on the size of the ovaries (the cut-off points being 8 and 12 cm), amount of ascites, severity of the symptoms and laboratory alterations, the patient will be classified with a mild, moderate, severe or critical OHSS, and will be managed conservatively in the two or three first stages, but will need hospital admission, sometimes even in the ICU in the last stage [1].
In the case of our patient, as she had not much ascites, the ovarian size was under 12 cm and there were no other relevant symptoms or laboratory alterations, she was diagnosed with moderate ovarian hyperstimulation syndrome and managed outpatiently, with a favourable evolution.

Differential Diagnosis List

Final Diagnosis

Ovarian hyperstimulation syndrome.

URL:	https://www.eurorad.org/case/13847
DOI:	10.1594/EURORAD/CASE.13847
ISSN:	1563-4086