Chorionic gonadotropin
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Ovarian hyperstimulation syndrome: case report A 31-year-old woman, who had undergone in vitro fertilisation and chorionic gonadotropin therapy for tubal factor infertility, developed ovarian hyperstimulation syndrome resulting in ureteral obstruction. The woman, who had received an unstated dosage of chorionic gonadotropin, presented with an 8-day history of vomiting, nausea, and intermittent left flank pain [time to onset of reaction not clearly stated]. Ultrasonography showed a large left ovary with multiple follicles and moderate right pelvocaliectasis. Her β-human chorionic gonadotropin level was 1500IU (normal undetectable). A diagnosis of ovarian hyperstimulation syndrome was made and she was discharged. Two and 5 days later, she presented with creatinine levels of 1.4 and 1.7 mg/dL (normal 0.3–1.4), respectively; her flank pain had resolved. Repeat ultrasonography showed increasing moderate right, and new mild left, pelvocaliectasis. She had a hyperplastic right adnexa which, at its greatest dimension, measured 10cm, and a hyperplastic left adnexa that had not changed in size since her last examination. Her β-human chorionic gonadotropin level was 7000IU. She was hospitalised. Under spinal anaesthesia, a right indwelling ureteral stent was placed for her moderate right hydronephrosis. Her creatinine level stabilised at 1.6 mg/dL, and the following day she was discharged. One month after the stent placement, ultrasonography showed multiple intrauterine pregnancies and improved right hydroureteronephrosis; her left hydronephrosis had progressed despite a decreased creatinine level (1.0 mg/dL). Three months after initial placement, her right ureteral stent was removed. Subsequent ultrasounds showed stable bilateral hydroureteronephrosis. A decrease in serum creatinine level to 0.6 mg/dL was also observed. At 32 weeks’ gestation, she delivered four neonates, and followup ultrasonography 4 months later revealed resolution of her bilateral hydroureteronephrosis. Author comment: "The pathophysiology [of ovarian hyperstimulation syndrome] has not been clearly defined, but it is thought to relate to increased capillary permeability owing to augmented cytokine excretion by the ovary under the influence of [chorionic gonadotropin]." Wiygul JB, et al. Ovarian hyperstimulation causing ureteral obstruction in a pregnant woman. Urology 67: 1085.e5-1085.e6, No. 5, May 2006 801042129 USA
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Reactions 19 Aug 2006 No. 1115
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