April 8th, 2020

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Severe Ovarian Hyperstimulation Syndrome in Patients with Autoimmune Disorders: A Report of Two Cases
Authors:  C. Rachel Kilpatrick, M.D., Valerie S. Ratts, M.D., Elan Simckes, M.D., and Janet B. McGill, M.D.
BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) following ovulation induction is common and varies in severity from mild to severe. Severe OHSS can be life threatening and requires hospitalization and procedures to reduce the extracellular fluid accumulation. Ovulation induction regimen and patient characteristics such as young age and low body weight have been identified as risk factors for OHSS, and follicle count >20 may be predictive of increased risk for moderate to severe OHSS. Whether any other patient factors are important in this risk equation is unknown.
CASES: We report on 2 patients with type 1 diabetes mellitus (T1DM) and other autoimmune diseases who experienced a total of 4 episodes of OHSS, 2 of which were severe.

CONCLUSION: T1DM, with or without other concomitant autoimmune diseases, may increase the risk for severe OHSS. Awareness of the interaction of preexisting conditions and risk for vascular leak disorders is needed for comprehensive counseling prior to embarking on ovarian stimulation. Preventive measures may be important considerations in this population.
Keywords:  capillary permeability, in vitro fertilization, ovarian hyperstimulation syndrome, ovulation induction, type 1 diabetes mellitus
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