Sudden Death Due to Severe Ovarian Hyperstimulation Syndrome

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic disorder associated with controlled ovarian stimulation during assisted reproductive technology. Severe OHSS may impose serious complications, including pleural effusion, acute renal insufficiency, venous thrombosis, and even death, although lethal outcomes are rare in forensic practice. The reported incidence of severe OHSS ranges from 0.008% to 10%. Herein, we present the case of a 29-year-old woman who diagnosed with polycystic ovary syndrome and infertility chose to undergo assisted reproduction. She received leuprorelin acetate and follicle stimulating hormone prior to egg retrieval. Three days after the retrieval procedure, she developed abdominal pain and distension. Later that same day, she died unexpectedly. The subsequent autopsy revealed turbid effusions of pleural and peritoneal cavities, abnormal ovarian enlargement, and duskiness of multiple organ surfaces. Microscopic examination disclosed edema and hemorrhage in follicles of both ovaries, thrombosis within the myocardial matrix, and massive pulmonary edema. Routine toxicology screening was negative. The death was attributed to severe OHSS. This case provides a morphologic reference for clinical and forensic work. Autopsy findings in instances of severe OHSS provide valuable insight into the mechanisms and pathogenesis of this disease.

Risk of ovarian hyperstimulation syndrome in women with malignancies undergoing treatment with long-acting gonadotropin-releasing hormone agonist after controlled ovarian hyperstimulation for fertility preservation: a systematic review

“…10 Although all patients in these case reports eventually recovered after intensive treatment, it is important to note that in severe cases, OHSS can be a life-threatening condition that requires immediate medical attention and intervention to prevent serious complications such as thromboembolism, renal failure, and respiratory distress syndrome. 24,25 In this context, it is important to consider the potential risks associated with the use of longacting GnRHa as an ovulation trigger in patients undergoing COH, particularly in the setting of cancer treatment. One study suggested the use of this approach, 17 but it may not be appropriate for cancer patients who need to start treatment as soon as possible to achieve optimal results.…”

“… 10 Although all patients in these case reports eventually recovered after intensive treatment, it is important to note that in severe cases, OHSS can be a life-threatening condition that requires immediate medical attention and intervention to prevent serious complications such as thromboembolism, renal failure, and respiratory distress syndrome. 24 , 25 …”

Sudden death of an egg donor during oocyte retrieval due to ovarian hyperstimulation syndrome

“… 12 - 15 However, no fatal case has been reported yet. Wang et al 16 reported the sudden death of a 29-year-old woman due to severe ovarian hyperstimulation syndrome in the aftermath of assisted reproduction technology and ovarian puncture. At autopsy, turbid effusions of pleural and peritoneal cavities, abnormal ovarian enlargement, and duskiness of multiple organ surfaces were observed.…”

Fertility Preservation and Ovarian Hyperstimulation Syndrome Management in Cancer Care: A Pathophysiological Perspective on Gonadotropin-Releasing Hormone Agonists and Antagonists

“…The development of OHSS may necessitate delaying critical cancer treatments, which can affect patients’ prognosis [ 40 , 41 ]. While OHSS is usually manageable with intensive medical intervention, its severe manifestations carry significant risks, including thromboembolism, renal failure, and respiratory distress syndrome [ 42 ].…”