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

Richard Lucidi, MD; Jordan Hylton, DO

Disclosures

May 28, 2021

The increased capillary permeability seen in ovarian hyperstimulation syndrome is triggered by increased vascular endothelial growth factor (VEGF) that is secreted during maturation and ovulation of ovarian follicles. This causes a fluid shift from the intravascular space into third space compartments. Renal effects are secondary to the extravasation of this fluid, causing decreased renal perfusion, sodium retention, and acidosis. Individuals with ovarian hyperstimulation syndrome are at risk for thromboembolic events that are likely secondary to hemoconcentration and hypercoagulation, resulting from the hyperestrogenic state.[1,4,5]

Risk factors for ovarian hyperstimulation syndrome include luteinization of multiple follicles, as seen in assisted reproductive techniques. Luteinization of multiple follicles is most often seen in the exogenous gonadotropic administration for oocyte induction, either with human chorionic gonadotropin or gonadotropin-releasing hormone. Ovarian hyperstimulation syndrome rarely occurs with clomiphene citrate or letrozole, which are used for ovulation induction in female infertility. Other risk factors include young age, low body weight, polycystic ovary syndrome, thyroid disease, high doses of exogenous gonadotropins, and a personal history of ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome is classified according to clinical and laboratory findings. Grade I or mild hyperstimulation includes multiple follicular cysts, estradiol level higher than 1500 pg/mL, and progesterone concentration greater than 30 ng/mL. Grade II or moderate hyperstimulation involves ovarian enlargement (≤ 12 ×12 cm) with abdominal discomfort, gastrointestinal symptoms, and sudden weight gain (> 3 kg), such as was experienced by the patient in this case. The above factors, along with ascites, electrolyte imbalance, and hypovolemia, defines grade III or severe hyperstimulation.[1,5,6]

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