Liver dysfunction in severe ovarian hyperstimulation syndrome

Abstract

We report the case of a 32-year-old woman suffering from severe liver dysfunction in the course of ovarian hyperstimulation syndrome (OHSS). Complications occurred after successful fertilization subsequent to ovarian stimulation with human menopausal gonadotropin followed by ovulation induction with human chorionic gonadotropin. Because of nausea, vomiting, abdominal distention and enlarged ovaries on an ultrasound examination, she was admitted on the diagnosis of OHSS. During the course of hospitalization severe hepatic injury developed. An increase of more than 100-fold in blood aminotransferase activity was observed. Applied treatment resulted in gradual reduction of ovarian size and resolution of ascites, as well as pleural and pericardial effusions. The patient was discharged from hospital after 46 days. Follow-up examinations at the 13th and 32nd weeks of gestation did not reveal any abnormalities. Pregnancy developed without complications and the woman went into spontaneous labor, giving birth to a viable child at 38 weeks' gestation. Taking into account the above case and previously published reports, the issue of liver dysfunction may have a great impact on the understanding both the pathology and the treatment of OHSS.

Ovarian stimulation and liver dysfunction: Is a clinical relationship possible? A case of hepatic failure after repeated cycles of ovarian stimulation

“…However, some pathophysiological explanations are conceivable. Some authors have reported cases of liver injury after ovarian stimulation [5-7]. Autopsies performed on patients who died from OHSS showed interesting hepatic histological lesions.…”

Ongoing Twin Pregnancy in an Obese, Polycystic Patient with Early Critical Ovarian Hyperstimulation Syndrome and Severe Liver Dysfunction: Case Report

“…It is the treatment of choice for patients with IHCP, and safe for the mother and the fetus. 2 In conclusion, we suggest that, during COH of obese, polycystic, insulin resistant patients, much more caution must be taken to prevent OHSS due to the vulnerability of obese patients to LD associated with nonalcoholic fatty liver disease, IR and metabolic syndrome. Family history of HG, OC induced cholestatic hepatitis, IHCP should also be known before COH.…”

“…Highest peak transaminase levels were reported by Davis et al (AST 756 U/L, ALT 4622 U/L). [2][3][4] The pathophysiology of the condition was suggested to be intrahepatic cholestasis (IHCP) due to elevated maternal estrogens and progestins during pregnancies conceived through assisted reproduction techniques (ART). In support of the etiologic role of estrogen, the risk of IHCP and hyperemesis gravidarum (HG) is increased in multiple gestations and in mothers of female offspring as in the presented case.…”

Predictors of Paracentesis in Women with Severe Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study

“…For example, the risk of venous thrombosis is significantly elevated and ischemic stroke has been described as a rare, but severe complication of OHSS in a number of studies [20,21,22,23,24,25,26,27,28,29]. Other rare complications include severe liver damage [30] and forearm amputation after repeated axillary vein thrombosis [31]. Three cases of OHSS-associated mortality were reported in the identified studies [32,33,34].…”

“…In contrast to the large body of literature investigating the pathophysiology and prevention of OHSS, only a few studies have been published so far about the natural course of this disorder, the clinical outcome of affected women, and useful predictors of paracentesis. A PubMed search using the search terms, OHSS, outcome, recovery, treatment, and paracentesis (search date April 20, 2015), yielded 68 studies with 27 reporting on clinical outcomes among women with OHSS [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. Enskog et al [8] found that severe OHSS developed in 18 out of 428 (4%) women after controlled ovarian stimulation/IVF and was associated with a higher prevalence of allergy and a higher live birth rate compared to women after controlled ovarian stimulation/IVF without OHSS.…”