Chorionic gonadotropin/leuporelin
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Ovarian hyperstimulation syndrome: case report An approximately 23-year-old woman developed ovarian hyperstimulation syndrome (OHSS) following treatment with leuprorelin and chorionic gonadotropin for ovulation induction. The woman presented with a 2-year history of primary infertility. She had a family history of type 2 diabetes mellitus (to mother). Prior to the presentation, she had received two ovulation induction (OVI) cycles with clomifene [clomiphene citrate], and one cycle with clomifene plus unspecified gonadotropins; however, she failed to ovulate. At current presentation, she was obese with features of hyperinsulinaemia and acanthosis nigricans. On the basis of her presenting symptoms and investigations, she was diagnosed with polycystic ovary syndrome (PCOS). She was advised lifestyle intervention and weight loss strategies. She was started on metformin 500mg tablet three times per day as an insulin sensitiser. Three months later, OVI was performed with clomifene 100mg for 5 days from day 2 of cycle along with unspecified injectable gonadotropins, but she failed to ovulate. In the setting of OVI failure, she underwent laparoscopic ovarian drilling (LOD) of bilateral ovaries in 2016. Following this procedure, she responded to the OVI. She underwent three cycles of OVI plus intrauterine insemination (IUI) with oral letrozole and unspecified injectable gonadotropins. She successfully conceived in the third cycle of OVI plus IUI. She received luteal phase support with progesterone hormonal therapy. However, she suffered spontaneous miscarriage after 1 week overdue. Two months later, she underwent OVI with unspecified injectable gonadotropins for 14 days with the formation of three dominant follicles. Ovulation trigger was given with SC leuprorelin [leuprolide acetate] 1mg followed by IM human chorionic gonadotropin [chorionic gonadotropin] 1500IU on day of the IUI. Following this, she conceived. However, the woman developed moderate late-onset OHSS, which was conservatively managed. At 6 weeks period of gestation (POG), this pregnancy also ended with spontaneous miscarriage. After two to three further treatment cycles, she conceived again on unspecified gonadotropins but had a miscarriage at 3 months POG. In 2017, she underwent in-vitro fertilisation (IVF); however, she responded poorly and failed to conceive. She then again failed to ovulate following unspecified gonadotropins therapy. Following discussion of risks and benefits, she underwent second LOD in March 2019. In June 2019, she underwent another IVF with ovulation trigger. Following fresh embryo transfer, her urine pregnancy test was found to be positive. After 4 weeks of the embryo transfer, transvaginal scan showed a single live intrauterine pregnancy. At around 32 weeks of gestation, she developed severe preeclampsia and underwent preterm caesarean section at 34 weeks with a delivery of female baby weighing 2.4kg. The baby was kept in neonatal ICU for 10 days and then discharged in a stable condition. Mahey R, et al. Successful IVF outcome
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