Objective Comparison of metformin and N acetylcysteine on clinical, metabolic parameter and hormonal profile in women with polycystic ovarian syndrome. Design Prospective comparative study. Setting Obstetrics and Gynecology department in Kamala Nehru Memorial Hospital Allahabad.

Isolated pleural effusion is a rare presentation of severe OHSS. Two to four percent of women of reproductive age have subclinical hypothyroidism which is an uncommon association of late onset iatrogenic OHSS. This report describes an unusual patient with isolated unilateral pleural effusion and subclinical hypothyroidism as the only manifestation of late onset OHSS in a singleton pregnancy following in vitro fertilization (IVF). We have summarized current literature related to isolated pleural effusion in late OHSS and evaluated its pathophysiology and treatment options. Albumin infusion may be considered as a plasma expander whenever there is a planned third space drainage. Thyroid profile test in asymptomatic patients planning IVF will help to identify subclinical hypothyroidism. OHSS is a self-limiting condition and a timely diagnosis with aggressive management can be lifesaving.

Hemorrhagic ovarian cysts (HOCs) are frequently seen in reproductive age women, developing in the luteal phase of ovulatory cycles. Giant HOCs are rare, as bleeding inside a closed space causes acute pain leading to early diagnosis. Anovulation or oligoovulation is a defining feature of polycystic ovarian syndrome (PCOS), and hence, functional cysts are uncommon in PCOS patients. This report describes a young girl with PCOS and amenorrhea, presenting with a giant hemorrhagic ovarian cyst. Most hemorrhagic cysts undergo spontaneous resolution with follow-up. Our patient presented as a surgical emergency following torsion and rupture with hemoperitoneum. Torsion causes an obstruction in the blood flow leading to infarction and loss of ovarian viability. Early diagnosis and detorsion may help to preserve ovarian function.

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