Ascites after egg retrieval for in vitro fertilization

Ms. Phuong, 25 years old, had severe chest and abdominal pain 5 days after egg retrieval for IVF.

Previously, Ms. Phuong's egg retrieval process at a hospital in Ho Chi Minh City went quite smoothly. After the procedure, she felt bloated. On the flight back to Hanoi on October 24, her condition worsened, with severe abdominal pain and difficulty breathing. After the plane landed, she was transferred to Tam Anh General Hospital in Hanoi.

Doctors from the Obstetrics and Gynecology Center consulted with the Reproductive Support Center (IVF Tam Anh) to determine that the patient had ovarian hyperstimulation. Ultrasound showed that both ovaries were 4 times larger than normal, with many hemorrhagic cysts inside. Ms. Phuong had abdominal effusion and pleural effusion, causing abdominal pain, chest tightness, nausea, and difficulty breathing.

In more than 40 minutes, under the guidance of transvaginal ultrasound, the doctor aspirated more than two liters of abdominal fluid from the patient. Three days later, the patient's health stabilized, no more bloating, no more difficulty breathing, and he was discharged from the hospital.

The doctor aspirated Ms. Phuong's abdominal fluid. Photo: Provided by the hospital — The doctor aspirated Ms. Phuong's abdominal fluid. Photo *: Provided by the hospital*

According to Dr. Phan Ngoc Quy, ovarian hyperstimulation is a complication that accounts for about 3-10% of cases of egg stimulation for in vitro fertilization. This complication can occur right from the stage of ovarian stimulation injection, lasting until about 1-2 weeks after egg retrieval. When hyperstimulated, women feel uncomfortable, have abdominal pain, nausea... or some more dangerous complications such as abdominal effusion, cardiopulmonary effusion...

Overgrown ovarian cysts can cause ovarian torsion, possibly requiring ovarian removal, affecting a woman's fertility.

Doctor Quy said that Ms. Phuong was diagnosed correctly and promptly given emergency care in the same hospital, so the treatment process was quick, ensuring her health and ability to become a mother.

Ultrasound image of ovarian hyperstimulation. Photo: Provided by the hospital — Ultrasound image of ovarian hyperstimulation syndrome in a patient. Photo: *Provided by the hospital*

According to Dr. Quy, ovarian hyperstimulation can affect the assisted reproductive treatment cycle, prolong the treatment time, increase costs and risks. Preventing the risk of hyperstimulation is a priority for assisted reproductive units. Assisted reproductive doctors often screen for risks before giving ovarian stimulation injections, choose the regimen as well as prescribe the appropriate dose.

Depending on the condition and response to the drug, the doctor will prescribe a combination, increase or decrease the dosage, and guide appropriate diet and lifestyle. "The case of hyperstimulation during treatment at IVF Tam Anh is very rare, less than 1% per year," Dr. Quy added.

Doctors recommend that women at high risk or who have already shown signs of ovarian hyperstimulation should freeze all embryos and wait until their bodies have recovered before transferring them. Hyperstimulation progresses very quickly if the patient becomes pregnant. At that time, the high concentration of hCG hormone in the blood is the trigger for hyperstimulation reactions, making the disease worse. At this time, the pregnant woman must both treat severe hyperstimulation and maintain the pregnancy, which is very complicated, risky and expensive.

Khue Lam

* Patient's name has been changed

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