Persistent megalocystic ovary following in vitro fertilization in a postpartum patient with polycystic ovarian syndrome.
OBJECTIVE
Ovarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months.


METHODS
A 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed "kissing ovaries", which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts.


CONCLUSIONS
With the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery.
Ling
Shin-Yee
SY
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Chong
Kian-Mei
KM
Hwang
Jiann-Loung
JL
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D036861:Delivery, Obstetric; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy*; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology* / Q000503:physiopathology; D010062:Ovulation Induction / Q000009:adverse effects; D019152:Paracentesis; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D012086:Reoperation; D013997:Time Factors; D014463:Ultrasonography
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen