OHSS Complicated With PID and Pelvic Abscess after IVF in a 35 Year Old Woman: A Case Report and Review of the Literature

Abstract

Background: Ovarian hyper stimulation syndrome is an iatrogenic serious complication that presents after human chorionic gonadotropin stimulation or after the spontaneous peak of luteizing hormone. Pelvic inflammatory disease following the in vitro fertilization and oocyte retrieval is a rare and infrequent complication. Tubo-ovarian abscess has been described as rare and significant complication .We present an uncommon case according the literature in which rare complications of IVF are described. Methods:We present a case of a 35 year old female patient, gravida 1, para 0 with history of in vitro fertilization short protocol and oocytes retrieval before a month ,attended our hospital complaining for deep abdominal pain since 8 days with significant gynecological past history. Clinical evaluation proved abdominal pain on palpation without fever. Serum levels of C-reactive protein were significantly elevated reaching the plateau of 320,943. Results:Transvaginal ultrasonography noticed the presence of a big left adnexal formation max diameter 18 cm that could be attributed to marked inflammation. Behind this, free fluid detected by the presence of adhesions that could be attributed to hydrosalpinx. The diagnosis of ovarian hyper stimulation syndrome followed by pelvic inflammatory disease was made and she hospitalized for 10 days. The patient came to our hospital 3 months later for her follow up and the transvaginal examination revealed left tubo-ovarian abscess. A new transvaginal ultrasonography after 3 months was clearly improved compared to the previous images. Conclusion:Ovarian hyper stimulation syndrome which is complicated with pelvic inflammatory disease and especially pelvic abscess after in vitro fertilization and oocyte retrieval guided by ultrasound is a rare and simultaneously significant complication. Transvaginal ultrasonographical examination seems to be a pivotal tool primarily for the diagnosis and secondarily for the follow up of these infertile women.