Abstract
Research QuestionCan inadvertent pregnancies go unnoticed when initiating random-start ovarian stimulation (RSOS) despite monitoring? DesignCase series at the university-based tertiary-care fertility clinic. ResultsBetween June 2022 and December 2023, two cases of undetected early pregnancy at the onset of random-start ovarian stimulation were identified, both leading to severe ovarian hyperstimulation syndrome (OHSS) with hospitalization. ConclusionRSOS protocols add flexibility in fertility clinics when there is no intention of a fresh embryo transfer but may be associated with insidious risk of OHSS. We advocate for comprehensive consultation and serial monitoring of human chorionic gonadotropin (hCG) during stimulation while cautioning against overreliance on baseline hormone levels when initiating RSOS. If the benefits of RSOS seem limited, healthcare providers should consider delaying the stimulation to avert health, but also medicolegal, and financial complications.
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