Ovarian hyperstimulation syndrome without gonadotropin stimulation: an unusual response to a GnRH agonist

• Published in: BMJ case reports Vol. 17; no. 7; p. e260512
• Main Authors: Petch, Sarah, Bauman, Renato, Hatunic, Mensud, Allen, Cathy
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 18.07.2024; BMJ Publishing Group LTD
• Subjects: Abdomen; Ascites; Blood tests; Case reports; Creatinine; Cysts; Dopamine; Eggs; Embryos; Follicles; Headaches; Hemoglobin; Iatrogenesis; Menstruation; Obstetrics and gynaecology; Obstetrics, gynaecology and fertility; Oophorectomy; Ovaries; Patients; Pituitary disorders; Reproductive medicine; Reproductive technologies; Sperm; Thromboembolism; Thyroid gland; Tumors; Ultrasonic imaging; Vascular endothelial growth factor
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2024-260512

Ovarian hyperstimulation syndrome (OHSS) is a well-known iatrogenic complication of ovarian stimulation with gonadotropins. We present the case of a woman in her 30s who developed OHSS without the administration of gonadotropins. She was due to undergo intracytoplasmic sperm injection (ICSI) for primary subfertility. After taking a gonadotropin-releasing hormone (GnRH) receptor agonist for 3 weeks, she presented with abdominal pain, nausea and bloating. She was diagnosed with moderate to severe OHSS, requiring management as an inpatient.Investigations included a pelvic ultrasound scan showing an enlarged ovary, serum oestradiol >30 000 pmol/L and an MRI of the brain with an incidental finding of a 5 mm pituitary microadenoma.She recovered rapidly and was referred for endocrinology evaluation and multidisciplinary team discussion. The OHSS was felt to be explained by an unusual ‘flare’ response to a GnRH agonist. A further ICSI cycle with an antagonist protocol is planned.