Two cases of cholestasis in the first trimester of pregnancy after ovarian hyperstimulation

Objective: To report two cases of early onset cholestasis of pregnancy associated with IVF and ovarian hyperstimulation syndrome. Design: Case report. Setting: University-based IVF program. Patient(s): Two patients with first-trimester cholestasis of pregnancy after IVF that was associated with ovarian hyperstimulation syndrome. Intervention(s): In vitro fertilization-embryo transfer, management of hyperstimulation syndrome, and cholestasis of pregnancy. Main Outcome Measure(s): Clinical pregnancy course and pregnancy outcomes. Result(s): The first patient was treated with ursodeoxycholic acid and had resolution of symptoms within the first trimester. The second patient initially had a miscarriage but did redevelop cholestasis of pregnancy in the latter stages of a pregnancy resulting from frozen embryo transfer. Conclusion(s): We report two cases of intrahepatic cholestasis of pregnancy in the first trimester of pregnancies by IVF in association with ovarian hyperstimulation syndrome and markedly elevated maternal serum estrogen levels. Early recognition of this unusual clinical presentation allows for optimal pregnancy management by both the reproductive endocrinologist and the obstetrician. (Fertil Steril (R) 2008;90:1202.e7-e10. (C) 2008 by American Society for Reproductive Medicine.)