Atypical presentation of severe ovarian hyperstimulation syndrome complicated by isolated pleural effusions: a case series and literature review.
Pleural effusion can be a rare manifestation of severe ovarian hyperstimulation syndrome, requiring prompt management and drainage for patient recovery.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study presents a retrospective case series of three patients who developed large pleural effusions after medically assisted reproduction in 2024-2025. All patients underwent antagonist stimulation with human chorionic gonadotropin (hCG) trigger and single fresh day-5 blastocyst transfer. The patients required ultrasound-guided intercostal drainage and showed rapid improvement post-management.
Abstract
Pleural effusion as the predominant manifestation of severe ovarian hyperstimulation syndrome (OHSS) is rare and may occur with minimal or absent ascites. We present a recent retrospective case series from two UK centres describing presentation, investigations, management and outcomes of three patients developing large pleural effusions after medically assisted reproduction (MAR) in 2024-2025. All patients underwent antagonist stimulation with human chorionic gonadotropin (hCG) trigger and single fresh day-5 blastocyst transfer. Pleural effusions were diagnosed within a week of transfer, were predominantly right sided, and occurred despite modest ovarian enlargement and minimal or absent ascites. Patients required ultrasound-guided intercostal drainage with controlled outflow and albumin support. Pleural biochemistry was assessed in one case and this met 'Light's criteria' for exudate effusions. All patients improved rapidly after drainage and supportive management. Two pregnancies continued (one to term, one viable at 7 weeks), and one cycle did not result in pregnancy. In conclusion, pleural-predominant OHSS is a rare, yet recognisable phenotype. Early thoracic ultrasound, with careful interpretation of pleural biochemistry (including the serum-pleural albumin gradient in equivocal cases), avoidance of diuretics, selective albumin for intravascular support, timely ultrasound-guided drainage and venous-thromboembolism prophylaxis can optimise management. These cases also highlight the importance of preventive OHSS measures for future cycles.
Background
The paper addresses the clinical presentation and complications associated with severe ovarian hyperstimulation syndrome (OHSS), a condition that can arise from fertility treatments. Previous literature has documented various complications of OHSS, but isolated pleural effusions are less commonly reported. This study aims to expand the understanding of OHSS presentations and their management.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Key findings
- Not reported in abstract.
Limitations
- Not reported in abstract.