C43-16 A Reproductive Twist: Concurrent Pulmonary Manifestations as the Primary Presentation of Ovarian Hyperstimulation Syndrome

Abstract Ovarian hyperstimulation syndrome (OHSS) is a known complication of in-vitro fertilization (IVF) usually presents ascites and abdominal pain. Although uncommon, the hormonal shifts causing OHSS and ascites can also precipitate formation of venous thromboembolisms (VTE), pulmonary embolisms (PE), and pleural effusions. Here we present a rare case of PE and pleural effusion secondary to IVF treatment and OHSS. A 39-year-old female, with history of hypertension, uterine fibroids, and actively undergoing her first cycle of IVF with choriogonadotropin alfa trigger and egg retrieval preformed 5 days prior to presentation. She was being treated for OHSS as an outpatient. She presented to the emergency department with a 1-day history of chest pain and dyspnea on exertion. On presentation she was afebrile, heart rate was 122 bpm, respiratory rate was 24 bpm, oxygenating at 94% on 2L nasal cannula. Lab work was notable for estradiol levels of approximately 6,000 pg/ml, D-Dimer 4.82 ug/mL FEU, and negative Beta-HCG. Chest CT angiography showed bilateral segmental and subsegmental PE without right heart strain and large right pleural effusion with mild ascites. Physical exam revealed decreased breath sounds on the right side with abdominal distention and tenderness. Anticoagulation with enoxaparin was initiated, and the patient underwent thoracentesis for her pleural effusion. Subsequent fluid studies met criteria for exudative effusion. The patient’s dyspnea improved, and she was discharged on anticoagulation with instructions to discontinue hormonal medications. Repeat imaging 2 months later revealed stable resolution of pleural effusion. Our case highlights the importance of clinicians recognizing, discussing, and mitigating the staggering risk and complications associated with IVF and OHSS. OHSS is a potentially fatal complication of IVF with a reported incidence rate of approximately 4.3-7% of patients undergoing IVF. Additionally, IVF increases the risk of VTE and PE by approximately 10-fold compared to women with natural pregnancy. While rare in the setting of OHSS, this risk increases 100-fold leading to an estimated incidence of 0.088%- 0.16% of all patients undergoing IVF. OHSS also represents a rare etiology of pleural effusions, though the mechanism and characteristics of OHSS associated pleural effusions are not well understood. Only a handful of case reports have documented large pleural effusions associated with OHSS. Cases of OHSS-related pleural effusions without significant ascites are even rarer. Further studies are needed to address the gap in practice when risk stratifying and treating patients undergoing IVF. This abstract is funded by: None