Ovarian hyperstimulation syndrome (OHSS) is characterized by increased vascular
permeability, hemoconcentration and fluid leakage to the third space. The vast
majority of OHSS cases occur following ovarian stimulation for IVF. This
potentially lethal iatrogenic condition is one of the most serious complications
of assisted reproductive technologies. We report one case of severe early OHSS
after GnRH agonist trigger in a GnRH antagonist protocol and freeze-all approach
without the administration of any hCG for luteal-phase support in a 34-year-old
case of PCO with 7 years primary infertility. After oocyte retrieval the patient
was seen at the emergency unit of the hospital with abdominal distension, pain,
anuria, dyspnea, and OHSS symptoms. The diagnosis was OHSS with severe ascitis.
She was admitted to the Intensive care unit (ICU). She was managed with oxygen
by mask, intravenous fluids, anticoagulant and albumen, we performed a two-time
vaginal ascites puncture, resulting in the removal of 7800mL of clear fluid in
Intensive Care Unit with full recovery. This case study presents the clinical
manifestations, investigation, progress, management, outcome and preventive
measures. The patient was managed with no complications. Clinicians have to be
aware that even the sequential approach to ovarian stimulation with a freeze-all
approach and GNRH analog triggering does not completely eliminate OHSS in all
patients.