EP11.13: Thrombosis following ovarian hyperstimulation syndrome in a 45‐year‐old woman

A 45-year old woman presented in the emergency with shortness of breath, vomiting, abdominal pain, distended abdomen, swollen legs after embryo transfer. The embryo transfer was done in the same cycle of ovarian stimulation and oocyte pick up regardless symptoms of OHSS(ovarian hyperstimulation syndrome) She had in the past 2 missed abortion and an extrauterine pregnancy. Laboratory findings: homozygous of MTHR (methylation receptor)1286A>C variant, normal thrombosis gene assay, normal cardiolipin antibodies. AMH 3.3 ng/mL, WBC 24.42×103/uL, RBC 5.56×106/uL, HGB 16.6 g/dl, HCT 47.2%. Low levels of Na, Cl, and albumin. AST 89 U/L,ALT 113 U/L, positive BHCG. During ultrasound examination we saw a 5 weeks intrauterine pregnancy, a lot of free fluid in the pouch of Douglas and the upper part of abdomen, uterus floating in the free fluid and enlarged ovaries, right ovary 82×71mm, left ovary 84×56 mm. Management was done using guidelines for OHSS treatment. The patient used enoxiparin 0.4ml. We did several abdominal punctures in order to take the fluid out. A week after the symptoms improved, the right leg remained swollen, different in colour. Doppler ultrasound revealed right femoral vein thrombosis despite the use of low molecular weight of heparin. The patient left the hospital in good condition at 11 weeks of gestation. She had a vaginal birth at term. She continued enoxiparin 6 weeks postpartum. In conclusion: using the predictive factors AMH(anti Myllerian hormone), AFC(antral follicle count) and patient health conditions can help using strategies like transferring the embryo in a later cycle. Once the early diagnosis of OHSS is established, it is crucial to use an anticoagulant treatment with heparin.