Thrombosis of Subclavian and Internal Jugular Veins Following Severe Ovarian Hyperstimulation Syndrome: A Case Report

Background: Ovarian hyperstimulation syndrome (OHSS) is a serious, albeit rare, complication of fertility treatment. In its severe form, it may be life-threatening. Increased vascular permeability with hemoconcentration is the hallmark of the syndrome. Vascular thromboembolism is a significant potential complication. Case: A previously healthy 26-year-old nulligravid woman developed severe OHSS following an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycle. She required hospitalization for treatment comprising IV fluid replacement, albumin infusion, paracentesis, and prophylactic heparin. She presented two days after discharge from hospital with left arm edema and neck pain. Subclavian and internal jugular vein thrombosis was diagnosed. Conclusion: OHSS is a serious complication of treatment for ovulation induction and is a significant risk factor for vascular thrombosis. Patients remain at risk even if given prophylactic heparin. The clinical presentation of OHSS may be unusual and late, indicating the importance of vigilance on the part of all physicians caring for patients who have undergone fertility treatment.