title: Myocardial infarction complicating the initial phase of an ovarian stimulation protocol.
abstract: Two previous reports have reported myocardial infarction during ovarian hyperstimulation syndrome, a complication of controlled ovarian stimulation characterized by ascites, pleural effusion, hemoconcentration and an increased thromboembolic risk, but no association with the initial phase (before treatment with human chorionic gonadotropin) of a normal ovarian stimulation protocol for infertility has ever been described. We report the first case, to our knowledge, of acute myocardial infarction occurring during the initial phase of an otherwise uncomplicated ovarian stimulation protocol. A young woman with infertility associated to polycystic ovary syndrome was treated with leuprolide acetate and recombinant follicle stimulating hormone to induce ovarian stimulation for in vitro fertilization and embryo transfer. After 12 days the patient presented a non-ST elevation myocardial infarction, which was treated with aspirin, clopidogrel, enoxaparin, intravenous nitrates and beta blockers. Cardiac catheterization showed angiographically normal coronary arteries. Echocardiography showed a circumscribed akinesis of the inferior apical segment of the left ventricle and right ventricular apex, which was confirmed by cardiac magnetic resonance. A screening for thrombophilic diathesis was negative. The patient was discharged and remained asymptomatic at 1 and 3 months follow up. Further ovarian stimulations were excluded and a trial of oocyte retrieval on spontaneous cycle was planned. Myocardial infarction can complicate ovarian stimulation protocols for infertility even in their early phase without any sign of ovarian hyperstimulation syndrome.
authors.forename: Stefano
authors.initials: S
authors.lastname: Coli
authors.forename: Marco
authors.initials: M
authors.lastname: Magnoni
authors.forename: Giulio
authors.initials: G
authors.lastname: Melisurgo
authors.forename: Paola
authors.initials: P
authors.lastname: Persico
authors.forename: Nicola
authors.initials: N
authors.lastname: Doldi
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.forename: Domenico
authors.initials: D
authors.lastname: Cianflone
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
mesh_terms: D000328:Adult; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects*; D005640:Follicle Stimulating Hormone / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D016729:Leuprolide / Q000009:adverse effects; D009203:Myocardial Infarction / Q000209:etiology*; D009765:Obesity / Q000150:complications; D010062:Ovulation Induction / Q000009:adverse effects*; D011085:Polycystic Ovary Syndrome / Q000150:complications
chemical_list: D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone; D016729:Leuprolide