A 24 year old underweight woman presents to you with progressive abdominal discomfo, dyspnoea, nausea and vomiting. Abdominal examination revealed cystic enlargement of ovaries. Relevant investigations results are as follows: Hematocrit - 57% Total count - 25000 /mm3 RFT -Impaired LFT - Mildly impaired USG - Massive ascites Serum peak oestradiol- 9000 pg/ ml X ray chest - shows pulmonary oedema History revealed that she had polycystic ovarian disease (PCOD) and was on treatment for infeility. She had received an injection last week from her infeility specialist. What is your diagnosis?

Here note that the serum peak oestradiol is very high and she had received an injection as a pa of her treatment for infeility which may have been human chorionic gonadotropin. This resulted in ovarian hyperstimulation syndrome. In Budd Chiari syndrome or Meigs syndrome oestradiol need not be this high. Note that thromboembolic complication may ensue ovarian hyperstimulation syndrome. Risk factors for ovarian hyperstimulation syndrome Age>35 years Asthenic habitus Pregnancy PCOS Serum oestradiol > 4000 pg/ml Luteal phase hcg stimulation >35 follicles Ref: Oxfords Handbook of clinical specialities, 8th Edition, Page 311