Ovarian Hyperstimulation and Maternal Virilisation with Successful Pregnancy Outcome

Abstract

Hyperreactio luteinalis (HL) and ovarian hyperstimulation syndrome (OHSS) during pregnancy are both benign conditions where the ovaries are enlarged with presence of multiple thin-walled cysts. Differential diagnosis is ovarian malignancy. Hyperandrogenism with resultant maternal virilization could be seen in some cases of HL as well as in androgen secreting tumours. We report the case of a 41 years old lady underwent ovulation induction due to secondary infertility. She had recurrent hospital admission with abdominal pain and huge multicystic enlargement of both ovaries. She developed virilisation features by 35 weeks of pregnancy. Lower segment caesarean section was done at 36 weeks gestation for breech presentation with intra uterine growth restriction. Magnetic resonance imaging (MRI) confirmed benign nature of the cysts. Ovarian cysts and hyperandrogenism gradually resolved by three months of delivery. Awareness, judicious imaging and close monitoring in such cases can result in live birth and avoid oophorectomies.
 Keywords: Hyperandrogenism; Hirsuitism; Virilism; Polycstic ovary syndrome; Ovarian hyper stimulation; Ovulation induction; Hyperreactio luteinalis; Ovarian cysts.