Subclavian deep vein thrombosis associated with the use of recombinant follicle-stimulating hormone (Gonal-F) complicating mild ovarian hyperstimulation syndrome.
OBJECTIVE
To describe two cases of subclavian deep vein thrombosis (DVT) associated with the use of recombinant gonadotropins and mild ovarian hyperstimulation syndrome (OHSS) and review the literature associated with this condition.


METHODS
Retrospective study (case report).


METHODS
Tertiary academic IVF program.


METHODS
Two women undergoing IVF with intracytoplasmic sperm injection due to male factor infertility.


METHODS
Ovaluation induction with recombinant FSH, IVF, and therapeutic heparinization.


METHODS
Coagulation studies, resolution of DVT, delivery at term.


RESULTS
Mild OHSS with left subclavian thrombosis occurred in two patients. Laboratory evaluation revealed normal protein C, protein S, antinuclear antibodies (ANA), and absence of antiphospholipid (APA) and anticardiolipin antibodies (ACA). Antithrombin III levels and coagulation studies were also within normal limits. Both patients tested negative for a factor V Leiden mutation and delivered healthy infants at term.


CONCLUSIONS
Arm swelling associated with the use of gonadotropins during controlled ovarian hyperstimulation should be promptly evaluated and treated. Subclavian vein thrombosis is a rare complication of ovulation induction, and the possibility that recombinant gonadotropins increase the risk for this complication should be further studied.
Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio, USA. loretdemola@uthscsa.edu
J R
JR
Loret de Mola
R
R
Kiwi
C
C
Austin
J M
JM
Goldfarb
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000009:adverse effects* / Q000627:therapeutic use; D043373:Follicle Stimulating Hormone, Human; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications*; D010062:Ovulation Induction / Q000009:adverse effects; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013350:Subclavian Vein; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000150:complications*
D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D005640:Follicle Stimulating Hormone