Abstract
Here we reported a rare case of misdiagnosed ectopic pregnancy (EP) due to unintended ovulation during controlled ovarian stimulation (COS) in GnRH agonist cycle, resulting in no oocytes harvested and late hyper-stimulation syndrome (OHSS). The patient was a 33-year old primary infertile woman due to male’s factors and underwent her second in vitro fertilization (IVF) cycle using GnRH agonist protocol, and no oocytes harvested on ovum picked-up (OPU) day. The start of gonadotropin usage was on day 8th of her period, and the P level increased rapidly and strangely high from day 8th after gonadotropin usage. The E2 level and follicles grew normally but finally no oocytes harvested. She was diagnosed as late ovarian hyper-stimulation syndrome (OHSS) 7 days after OPU. 20 days after OPU, no menstruation come and a positive urine test of hCG were reported. And the patient was diagnosed as EP by laparoscopy. In conclusion, rapidly increased P level, no oocyte retrieval and late onset of OHSS should be very important clues to diagnose this misdiagnosed EP.
Highlights
We reported a rare case of misdiagnosed ectopic pregnancy (EP) due to unintended ovulation during controlled ovarian stimulation (COS) in GnRH agonist cycle, resulting in no oocytes harvested and late hyper-stimulation syndrome (OHSS)
The patient was a 33-year old primary infertile woman due to male’s factors and underwent her second in vitro fertilization (IVF) cycle using GnRH agonist protocol, and no oocytes harvested on ovum picked-up (OPU) day
The E2 level and follicles grew normally but no oocytes harvested. She was diagnosed as late ovarian hyper-stimulation syndrome (OHSS) 7 days after OPU. 20 days after OPU, no menstruation come and a positive urine test of hCG were reported
Summary
Most of the cases reported so far are diagnosed before initiating ovarian stimulation by some hints such as delayed periods or no periods [2]. Seldom reports about the pregnancy occurred during ovarian stimulation. For those misdiagnosed cases, previous studies agreed that the GnRH-a had no harm to the pregnancy outcome during luteal phase down-regulation [3]. Cases reported that it could extract oocytes and obtain embryos following a superovulation procedure in early pregnant patients [4]. We here report a rare case of ectopic pregnancy (EP) occurred during Gn stimulation due to unintended ovulation, and ended with failure to retrieve any oocytes and onset of late hyper-stimulation syndrome (OHSS)
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