Ovarian hyperstimulation syndrome associated with clomiphene Citrate

Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chronic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a different diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with advance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction. (AU)

Are factors that influence oocyte fertilization also predictive? an assessment of 148 cycles of in vitro fertilization without gonadotropin stimulation

Fertilization characteristics of 152 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occured significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases on secondary infertility. Grade 1 sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progeterone (P), estradiol (E2), E2:P ratio, and luteinizing hormone (LH), as well as baleline plasma LH and the magnitude of the LH surge did not correlate with fertilization (descriminant analysis), only 58.3 percent of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right