Ovarian Hyperstimulation Syndrome: A Rare Cause of Iatrogenic Pleural Effusion

Assisted reproductive technology (ART) has seen a boom in recent years, Ovarian hyperstimulation occurring as a rare and potentially fatal consequence of the ART is an uncommon cause of pleural effusion especially among chest physicians. Etio pathogenesis revolves around shift of intravascular to extravascular space under the influence of VEGF due to increased capillary permeability. The case reported here is that of a young nulliparous female with polycystic ovaries which is progressive and leads to a bilateral pleural effusion and acute respiratory distress needing oxygen and ICU management. The patient was managed with colloid management and fluid therapy. Also evidence of DIC and abnormal coagualtion including DVT and Pulmonary embolism were evaluated and a final diagnosis was established to be OHSS. The pleural fluid reports were suggestive of a hemorrhagic exudative picture which regressed spontaneously after 7 days of ICU management. Possible preventive modalities include cancelling the cycle, coasting, individualizing the hCG trigger dose or using a GnRH trigger (for those using a GnRH antagonist protocol), the use of IV fluids at the time of oocyte retrieval, and cryopreserving/vitrifying all oocytes. Awareness among physicians including chest physicians is vital to ensure prompt diagnosis and appropriate care for such patients.