11/32. Unilateral pleural effusion as the main presentation of "early onset" severe ovarian hyperstimulation syndrome.OBJECTIVE: To report a case of severe early onset ovarian hyperstimulation syndrome with unilateral pleural effusion and little ascites as the main presenting clinical signs. DESIGN: Case report. SETTING: University affiliated teaching hospital and in vitro fertilization (IVF) clinic. PATIENT(S): A 33-year-old woman known to have bilateral polycystic ovaries underwent IVF and became pregnant. INTERVENTION(S): Pleuracentesis. MAIN OUTCOME MEASURE(S): Resolution of symptoms, pregnancy outcome. RESULT(S): A total of 4,200 mL of pleural fluid was drained from the right hemithorax. Complete resolution of symptoms did not occur until 16 weeks' gestation. The pregnancy progressed normally until 27 weeks when spontaneous preterm labor resulted in a vaginal delivery of a live female infant weighing 880 grams. CONCLUSION(S): This case described is unusual in that the patient presented with significant right-sided pleural effusions on day 2 after embryo transfer and continued to be symptomatic until 16 weeks' gestation. This is much earlier than any previously described case report of isolated unilateral pleural effusion associated with ovarian hyperstimulation syndrome.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
12/32. Successful pregnancies in patients with estrogenic anovulation after low-dose human chorionic gonadotropin therapy alone following hMG for controlled ovarian hyperstimulation.OBJECTIVE: To demonstrate that folliculogenesis can be sustained with 200 IU human chorionic gonadotropins (hCG) after FSH-priming and result in pregnancy in women with estrogenic ovulatory dysfunction and risk factors for severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Case report: Three women with infertility associated with estrogenic ovulatory dysfunction and hyperinsulinemia who appeared to be at high risk for severe OHSS during gonadotropin therapy. INTERVENTIONS: After 10 days of receiving either 150 IU hMG or recombinant FSH, patients were switched to 200 IU hCG/day alone for 2-3 days. 5,000 IU of hCG was then administered followed by either home intercourse, intrauterine insemination or transvaginal oocyte retrieval-embryo transfer. MAIN OUTCOME MEASURES: Endovaginal ultrasound measurement of follicle number and size, serum estradiol levels, symptoms of ovarian hyperstimulation, pregnancy test, and evaluation of pregnancy by transvaginal ultrasound. RESULTS: After discontinuation of hMG or recombinant FSH, serum estradiol concentrations continued to rise, and follicles >14 mm continued to grow during low-dose hCG administration. All women conceived without developing symptoms of OHSS. Pregnancy outcomes achieved include a term singleton delivery, a term twin delivery, and triplets delivered at 31 weeks gestation. CONCLUSION: The use of low-dose hCG alone is sufficient for supporting the late stages of folliculogenesis in women with estrogenic ovulatory dysfunction. This ovulation induction regimen appears to support the follicular growth of larger follicles while decreasing the number of smaller preovulatory follicles, thereby reducing a known risk factor for OHSS. We report on the positive pregnancy outcomes in 3 women with estrogenic ovulatory dysfunction and clinically appeared to be at high risk for developing severe OHSS who safely underwent this protocol.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
13/32. Case report: delirium associated with ovarian hyperstimulation syndrome.ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproductive technologies. Mild OHSS is characterized by ovarian enlargement and abdominal discomfort. In severe cases anasarca, hepatic dysfunction, reduced blood volume, electrolyte imbalance, organ failure and thromboembolic phenomena may be observed. delirium is a syndrome, not a disease, and has many causes, all of which result in a similar pattern of signs and symptoms relating to a patient's level of consciousness and cognitive impairment. delirium remains an under-recognized and under-diagnosed clinical disorder. The case is presented of a 30-year-old woman with OHSS and delirium. She underwent intracytoplasmic sperm injection (ICSI) for severe male factor infertility. Five days after oocyte retrieval, ascite formation was observed in ultrasonographic evaluation, and embryo transfer was cancelled. Twelve days after retrieval she came to the emergency clinic with abdominal distension and pain. She was hospitalized and paracentesis was performed every other day three times. She had altered consciousness and psychomotor hypoactivity 1 h after the last paracentesis. Psychiatric consultation revealed that she was in a state of delirium, and haloperidol was administered for treatment. Her symptoms disappeared within a week. Her medication was stopped when symptoms resolved and she was still asymptomatic in psychiatric evaluation 1 week later.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
14/32. Use of recombinant human activated protein c in treatment of severe sepsis in a pregnant patient with fully symptomatic ovarian hyperstimulation syndrome.BACKGROUND: Severe sepsis during pregnancy is a life-threatening condition for the mother, due to multiorgan failure and uncontrolled inflammatory response. It is associated with high risk of death for the fetus. CASE REPORT: The paper presents the course and treatment of severe iatrogenic sepsis in a patient in very early pregnancy. The sepsis was a result of complications after overstimulation of the ovaries in the course of treatment of infertility. The risk of the patient's death, assessed in the intensive care Unit according to apache II and SAPS II scores was 73%, whereas indirect assessment of the embryo in the 3(rd) week of pregnancy, based on determination of serum gestational hormone levels was ambiguous, but rather unfavorable. The patient's condition improved considerably after intensive treatment, including, among others, the use of activated protein c (APC). After the completion of treatment, in the 5(th) week of pregnancy, the gestational hormone levels increased to the values appropriate for such fetal age. The development of pregnancy was also confirmed by ultrasonography. CONCLUSIONS: The paper presents a case of severe sepsis in the course of ovarian hyperstimulation syndrome, not described in the literature so far, as well as the first successful administration of activated protein c in 21-day pregnancy.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
15/32. Development of severe ovarian hyperstimulation syndrome after inadvertent stimulation with a gonadotropin-releasing hormone agonist and human menopausal gonadotropin in a pre-existing early pregnancy.OBJECTIVE: To report a case of severe ovarian hyperstimulation syndrome (OHSS) after inadvertent GnRH long protocol/hMG stimulation in a pre-existing early pregnancy. DESIGN: Case report. SETTING: Private infertility clinic. PATIENT(S): A 28-year-old woman who conceived spontaneously following IVF and cryo-embryo transfer (cryo-ET). INTERVENTION(S): IVF/intracytoplasmic sperm injection (ICSI), cryo-ET, analgesia, and forced diuresis. MAIN OUTCOME MEASURE(S): Viable pregnancy. RESULT(S): Viable pregnancy with OHSS despite inadvertent administration of GnRH-agonist, stimulation with hMG, and ET in a pre-existing pregnancy. CONCLUSION(S): observation of follicle development following stimulation during pregnancy with low quantity and poor quality oocytes combined with abnormal endometrium.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
16/32. Mild ovarian hyperstimulation syndrome coexisting with ectopic pregnancy after in vitro fertilization.ovarian hyperstimulation syndrome (OHSS) is an entity arising in women undergoing assisted reproductive techniques (art). The simultaneous presence of two different clinical complications such as OHSS and ectopic pregnancy (EP) is not frequent. The diagnosis of an extrauterine pregnancy can be obscured by the stimulated ovaries and ascites, and actually be missed, especially in women with increased body mass index. We report a case of a woman who presented with mild OHSS after in vitro fertilization (IVF), (intracytoplasmatic sperm injection (ICSI) and embryo transfer). The ectopic pregnancy was ascertained soon after by transvaginal ultrasound (TVS) and right salpingectomy was performed.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
17/32. Acute decline in renal function as a consequence of ovarian hyperstimulation syndrome.Two cases of severe ovarian hyperstimulation syndrome following ovulation induction are described, one of them following in vitro fertilization and embryo transfer, and the other after conventional ovarian stimulation. This condition was associated with an acute reversible decline in renal function. The treatment and the possible pathophysiological mechanisms are discussed.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
18/32. Severe ovarian hyperstimulation despite prophylactic albumin at the time of oocyte retrieval for in vitro fertilization and embryo transfer.OBJECTIVE: To report two cases of severe ovarian hyperstimulation syndrome (OHSS) despite the administration of 50 g IV albumin at the time of oocyte retrieval. Two previous published series failed to observe OHSS in patients receiving prophylactic IV albumin. DESIGN: case reports of two women undergoing controlled ovarian hyperstimulation with E2 > 4,500 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration who developed OHSS despite prophylactic albumin administration. SETTING: The division of reproductive endocrinology at the Mount Sinai Medical Center. INTERVENTIONS: Fifty grams IV albumin (200 mL of a 25% albumin solution) were administered over 30 minutes at the time of oocyte retrieval. MAIN OUTCOME MEASURES: Prevention of interstitial fluid accumulation such as ascites, pleural effusions, and generalized edema. The other goals of albumin administration included avoiding hemoconcentration, renal insufficiency, and thrombotic complications. RESULTS: The patients developed sequelae of severe OHSS requiring hospitalization, despite administration of IV albumin. CONCLUSION: Albumin is a promising agent in the prevention of OHSS. However, until the basic pathophysiology of this disorder can be elucidated, the mechanism of its action will remain elusive. Attempts to quantify and report clinical outcomes and the ultimate completion of a prospective randomized study will assist in the prevention and management of this enigmatic disorder.- - - - - - - - - - ranking = 4keywords = embryo (Clic here for more details about this article) |
19/32. Multiple follicular development associated with herbal medicine.After three endocrinologically normal cycles while undergoing unstimulated in-vitro fertilization treatment, a woman took a herbal medicine (vitex agnus castus) at the beginning of a fourth unstimulated IVF treatment cycle. In this fourth cycle, her serum gonadotrophin and ovarian hormone measurements were disordered. One embryo resulted from the three eggs collected but a pregnancy did not ensue. She had symptoms suggestive of mild ovarian hyperstimulation syndrome in the luteal phase. Two subsequent cycles were endocrinologically normal. We do not advocate the use of this herbal medicine to promote normal ovarian function.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
20/32. Severe ovarian hyperstimulation syndrome, selective embryo reduction and heterotopic pregnancy.ovarian hyperstimulation syndrome is common (21.4%) in patients with polycystic ovarian disease, treated by gonadotrophins. It is much frequent (50%) in conceptual cycles. We report a case associated with a quadruplet pregnancy that underwent selective embryo reduction at 8 weeks' gestation to a twin pregnancy and was subsequently found to have an unruptured ectopic pregnancy at 11 weeks' gestation. After laparotomy and partial salpingectomy a successful twin pregnancy ensued.- - - - - - - - - - ranking = 5keywords = embryo (Clic here for more details about this article) |
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