Ovarian hyperstimulation syndrome or massive intraperitoneal hemorrhage?

21 06 2011

To the Editor:

I read with interest a recent paper by Griesinger et al. (1) describing, for the first time in the English literature, a case of severe ovarian hyperstimulation syndrome (OHSS) post-GnRH agonist trigger of ovulation. However, the clinical details of the case cast serious shadow on the correct diagnosis.

The hallmark of severe OHSS is elevated hematocrit (>45%, or >30% increment over baseline values) secondary to hemoconcentration (2). However, the described patient experienced severe intraperitoneal hemorrhage leading to decreasing hematocrit (41% on day of trigger, 37% on day of oocyte retrieval). Blood transfusion was given (no details on amount) due to “drastic decrease of hemoglobin levels to 4.9 mmol/L,” with hematocrit “15,000, oliguria, elevated creatinine, liver dysfunction, anasarca) were not given. Read the rest of this entry »