A unique variant of spontaneous ovarian hyperstimulation syndrome: case report

Tanya Buckshee Rohatgi, Kamal Buckshee


Spontaneous ovarian hyperstimulation syndrome (SOHSS) is extremely rare in naturally conceived pregnancies and is potentially a life-threatening condition. Objective of present study was to highlight the development of new and atypical findings associated with SOHSS in a woman who conceived naturally with singleton pregnancy while taking inositols and metformin. A 35 years old lady was under pressure to conceive, so she presented to us for fertility consultation and further management. Being a case of polycystic ovary syndrome (PCOS) with irregular periods, hyperandrogenism and dyslipidemia with raised blood sugar level, she was started on inositols and metformin to aid fertility and to improve endocrine and metabolic parameters. To evaluate the status of ovaries and endometrium, ultrasound (US) was done which revealed moderate amount of free fluid in pelvis, thickened endometrium and mild enlargement of ovaries with unusually small and atypical follicles. Pregnancy test and beta-human chorionic gonadotropin (βHCG) confirmed pregnancy. She was asymptomatic and was managed conservatively. Pregnancy progressed and at term, a healthy male baby was delivered. Awareness and suspicion of SOHSS in a PCOS case aided early diagnosis and timely management. Intake of type of pharmacological and non-pharmacological agents to be monitored for their impact on fertility, ovarian enlargement, severity of ovarian hyperstimulation syndrome (OHSS), clinical presentation, laboratory profile and outcome of pregnancy.


Inositols, Ovarian hyperstimulation syndrome, Polycystic ovary syndrome

Full Text:



Raoul O, Olga DS, Daniel L, Jigal H, Roy M, Yoram C. Interleukin-2 and SOCS-1 proteins involvement in the pathophysiology of severe ovarian hyperstimulation syndrome-a preliminary proof of concept. J Ovarian Res. 2014;7:106.

Leener AD, Montanelli L, Van Durme J, Chae H, Smits G, Vassart G, Costaglioola S. Presence and absence of follicle-stimulating hormone receptor mutations provide some insights into spontaneous ovarian hyperstimulation syndrome physiopathology. J Clin Endocrinol Metab. 2006;91:555-62.

Stolorz K, Nowosielski K, Włodarz IU, Sodowska P, Sodowski K. Ovarian hyperstimulation syndrome in spontaneous pregnancy. J Gynecol Res Obstet. 2016;2.1:005-9.

Demirel E, Turhan U, Ekmekci E, Subasioglu A, Kelekci S. Severe spontaneous ovarian hyperstimulation syndrome with cervical insufficiency: a case report. JFIV Reprod Med Genet. 2016;4:181.

Benelli E, Ghianda SD, Cosmo CD, Tonacchera M. Clinical study A Combined therapy with myo-inositol and d-chiro-inositol improves endocrine parameters and insulin resistance in PCOS young overweight women. Int J Endocrinol. 2016;3204083:1-5.

Olatunbosun OA, Gilliland B, Brydon LA, Chizen DR, Pierson RA. Spontaneous OHSS in four consecutive pregnancies. Clin Exp Obstet Gynecol. 1996;23:127-32.

Evelin ME, Ramiro Q, Carlos C, María VB, Gastón RV, Dante AP et al. Metformin decreases the incidence of ovarian hyperstimulation syndrome: an experimental study. J Ovarian Res 2013;6:62.

Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Freitas V. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2014;11:CD006105.

Smith V, Osianlis T, Vollenhoven B. Prevention of ovarian hyperstimulation syndrome: a review. Obstet Gynecol Int. 2015;2015:1-10.

Turan GA, Eskicioglu F, Sivrikoz ON, Cengiz H, Adakan S, Gur EB et al. Myo-inositol is a promising treatment for the prevention of ovarian hyperstimulation syndrome (OHSS): an animal study. Arch Gynecol Obstet. 2015;292:1163-71.

Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, Santis LD. Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Fertil Steril. 2009;91(5):1750-4.

Minnozi M, Costetino D, Gauraldi C, Unifer V. The effect of combination therapy with myo-inositol and combined oral contraceptive pill versus a combined oral contraceptive pill alone on metabolic, endocrine and clinical parameters in polycystic ovary syndrome. Gynecologic Endocrinol 2011;27(11):920-4.

Sharafeldin SMA, ELawad BE. Ovarian hyperstimulation syndrome in a 35-year old woman: A case report. Global Sci Res J. 2016;4(1):075-7.