Thromboembolism after ovarian stimulation: successful management of a woman with superior sagittal sinus thrombosis after IVF and embryo transfer: case report.
The current literature was reviewed in order to analyse the clinical manifestations, progression and management, and pregnancy outcome of thromboembolism in infertile patients undergoing ovarian stimulation. The first case of superior sagittal sinus thrombosis following IVF that was successfully managed with intracranial thrombectomy is also reported. This retrospective cohort study comprised 65 women who experienced thromboembolism after ovarian stimulation (64 from other published studies and the present case report). Thrombosis attack occurred at a mean (+/-SD) of 25.5 +/- 20.1 days after oocyte retrieval. The onset timing in the intracranial thrombosis group (10.2 +/- 4.6 days) was less (P < 0.05) than in those experiencing thromboembolism at other sites. Ovarian hyperstimulation syndrome (OHSS), haemoconcentration and high serum estradiol level were noted in 79, 62 and 54% of women respectively. Forty-eight of 55 patients (87%) who received anticoagulation recovered without sequelae. Among patients willing to continue pregnancy, 32% succeeded in term delivery with all healthy babies, and 23% were ongoing pregnancies. In conclusion, ovarian stimulation cycles accompanying high serum estradiol levels, haemoconcentration or OHSS are at potential risk of thromboembolism. Dose-adjusted heparinization is recommended as the first-line treatment of choice, while intravascular thrombolysis or operative thrombectomy is an aggressive but effective treatment. Continuation of pregnancy is considered safe, without any increased risk of fetal congenital anomalies.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Yu-Che
YC
Ou
Yeh-Lin
YL
Kao
Shung-Lon
SL
Lai
Fu-Tsai
FT
Kung
Fu-Jen
FJ
Huang
Shiuh-Young
SY
Chang
Chan-Chao
CC
ChangChien
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D009865:Oocytes; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D020225:Sagittal Sinus Thrombosis / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D013923:Thromboembolism / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000209:etiology*; D020858:Tissue and Organ Harvesting
D000925:Anticoagulants; D004958:Estradiol; D006493:Heparin