#74 : Rare Presentation of Bilateral Haemorrhagic Pleural Effusions in Ovarian Hyperstimulation Syndrome

Background and Aims: Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian hyperstimulation. Pleural effusions seen in OHSS usually are accompanied by marked ascites. Isolated pleural effusion without ascites is extremely rare. Here, we report a case of severe OHSS with rare presentation of isolated bilateral haemorrhagic pleural effusions following controlled ovarian hyperstimulation in in vitro fertilization (IVF).

Method: We present a case of a 31-year-old lady with polycystic ovarian syndrome (PCOS) undergoing IVF where antagonist regime was used. To reduce OH SS risk, agonist trigger was given followed by cryopreservation. The patient was discharged well after oocyte retrieval. She needed admission the following day due to worsening abdominal pain. Cabergoline was started together with analgesia. On day 4 admission, she developed left haemorrhagic pleural effusion which was drained. Her condition improved initially but pleural effusion recurred after a few days and this time was bilateral. Pleural fluid drainage was repeated.

Results: Patient recovered and was discharged well after 3 weeks of hospitalization. Five months later, we performed frozen embryo transfer where two day-3 embryos were transferred (both 8-cell Grade 1). She had a successful singleton pregnancy. At 38 weeks of gestation, she delivered a healthy boy weighing 3.67 kg via Caesarean section.

Conclusion: Pleural effusion as sole presentation of severe OHSS is a very rare occurrence. Despite close monitoring during ovarian stimulation and rigid guidelines, OHSS still occurs. Early detection and prompt intervention by a multidisciplinary team are crucial to ensure successful management of this serious complication.