A 28-Year-Old Writer With Bilious Vomiting After Egg Donation

Richard Lucidi, MD; Jordan Hylton, DO

Disclosures

May 28, 2021

Discussion

The TVUS revealed enlarged bilateral ovaries with numerous enlarged ovarian follicles, as well as a small amount of free fluid within the pelvis (Figure 1).

The patient's presentation as well as her laboratory and TVUS findings and history of oocyte retrieval are indicative of ovarian hyperstimulation syndrome.

Although many variations are recognized, the typical in vitro fertilization cycle begins with preliminary ovarian suppression using oral contraceptive pills and leuprorelin. This is followed by ovulation induction with gonadotropin (follicle-stimulating hormone) injections to stimulate multiple egg production. The progress of the induction is followed with TVUS and blood estrogen levels.

Between day 8 and day 12 of the induction, when follicles are judged to be mature, ovulation is triggered with an injection of human chorionic gonadotropin. Follicle aspiration with egg retrieval is carried out 36 hours later under ultrasound guidance, using a special needle via the vagina.

The incidence of ovarian hyperstimulation syndrome ranges from 0.25% to 6%. It is characterized by ovarian enlargement secondary to multiple ovarian follicles and an acute fluid shift from the intravascular space.[1,2] These fluid shifts can have significant impacts in severe cases of ovarian hyperstimulation, causing renal failure, hypovolemic shock, thromboembolic episodes, acute respiratory distress syndrome, and even death. Fever is documented in as many as 50% of cases. Leukocytosis is commonly seen and is often mistaken for an infectious etiology.[3]

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