menotropins and Liver-Diseases

We report the case of a 32-year-old woman suffering from severe liver dysfunction in the course of ovarian hyperstimulation syndrome (OHSS). Complications occurred after successful fertilization subsequent to ovarian stimulation with human menopausal gonadotropin followed by ovulation induction with human chorionic gonadotropin. Because of nausea, vomiting, abdominal distention and enlarged ovaries on an ultrasound examination, she was admitted on the diagnosis of OHSS. During the course of hospitalization severe hepatic injury developed. An increase of more than 100-fold in blood aminotransferase activity was observed. Applied treatment resulted in gradual reduction of ovarian size and resolution of ascites, as well as pleural and pericardial effusions. The patient was discharged from hospital after 46 days. Follow-up examinations at the 13th and 32nd weeks of gestation did not reveal any abnormalities. Pregnancy developed without complications and the woman went into spontaneous labor, giving birth to a viable child at 38 weeks' gestation. Taking into account the above case and previously published reports, the issue of liver dysfunction may have a great impact on the understanding both the pathology and the treatment of OHSS.

Topics: Adult; Alanine Transaminase; Aspartate Aminotransferases; Biopsy; Chorionic Gonadotropin; Female; Humans; Liver Diseases; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome

A 26-year-old married woman was admitted to our hospital because of massive ascites and hepatic injury. The patient had been treated with human menopausal gonadotropin and clomiphene citrate to prevent recurrence of spontaneous abortions. About 1 month later, she developed upper abdominal pain and noticed dark urine. On admission, she had elevated concentrations of serum transaminases with an asparate aminotransferase of 127 IU/L and alanine aminotransferase of 194 IU/L. An abdominal ultrasound showed massive ascites. Her serum concentration of estradiol was high at 12,100 pg/mL, which was much greater than the value of early stage of pregnancy (2,279-7,353 pg/mL). She was thus diagnosed as having ovarian hyperstimulation syndrome. Following a period of bed rest, her liver function normalized and the ascites disappeared. Based on the above findings, the patient was considered to have suffered from ovarian hyperstimulation syndrome, complicated by hepatic injury.

Topics: Abortion, Spontaneous; Adult; Bed Rest; Capillary Permeability; Chemical and Drug Induced Liver Injury; Clomiphene; Female; Fertility Agents, Female; Humans; Liver; Liver Diseases; Menotropins; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy Trimester, First

Ovarian hyperstimulation syndrome (OHSS) is a potentially fatal condition associated with the therapeutic induction of ovulation in infertility. Liver function abnormality has been previously reported in four patients, one of whom had ultrastructural abnormalities on liver biopsy. This paper describes a patient presenting with severe OHSS 16 days after ovulation had been induced. Liver function abnormality was apparent 11 days later, with a sustained rise in alkaline phosphatase and aspartate aminotransferase (AST) which lasted up to 2 months. A liver biopsy performed during the second month of her protracted hospital admission showed marked zonal fatty change (acinar zone 1) and associated inflammation, with mitochondrial crystalline inclusions and rough endoplasmic reticulum dilatation on electron microscopy. This report discusses the clinical features and possible aetiological factors.

Topics: Adult; Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Biopsy; Chorionic Gonadotropin; Female; gamma-Glutamyltransferase; Humans; Liver Diseases; Liver Function Tests; Menotropins; Ovulation Induction; Serum Albumin

Ovarian hyperstimulation syndrome (OHS) is one of the potential complications associated with the use of human menopausal gonadotropin therapy. We recently dealt with a case of severe OHS presenting features of liver dysfunction; such a case has not been reported on before.

Topics: Adult; Chemical and Drug Induced Liver Injury; Cytoplasm; Female; Humans; Infertility, Female; Liver Diseases; Menotropins; Mitochondria, Liver; Ovary; Ovulation Induction