Ob/Gyn Case Challenge: A 33-Year-Old Woman Trying to Conceive Has Dyspnea, Pain

Ziad R. Hubayter, MD, MPH


May 19, 2022

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 33-year-old woman, gravida 0, presents owing to sudden onset of shortness of breath 1 week after in vitro fertilization (IVF). Her shortness of breath began acutely earlier in the day, but she states that for the past few days, she has had generalized abdominal pain associated with distention, nausea, and occasional nonbloody, nonbilious vomiting. Her pain became worse overnight, and she states that it now hurts in her abdomen when she takes a deep breath. She also cannot lie flat because it exacerbates both the pain and the difficulty with breathing.

She has a known history of polycystic ovary syndrome (PCOS) and has failed to conceive for several years. Three weeks before presentation, controlled ovarian stimulation was performed with gonadotropins. A total of 25 oocytes were retrieved. The peak estradiol during ovarian stimulation was 4638 pg/mL. She then underwent transvaginal ultrasonography-guided oocyte retrieval, followed by embryo transfer 1 week before presentation.

The patient's medical history is otherwise unremarkable. Other than the recent hormonal therapy, her only medication has been a daily multivitamin, and she has no known drug allergies. She does not smoke or use illicit drugs or alcohol.


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