A 28-year-old woman with PCOS undergoes ovulation induction with clomiphene citrate 100 mg for 5 days. Follicular monitoring at Day 10 shows multiple follicles >18 mm. She develops sudden onset abdominal distension, nausea, and shortness of breath on Day 14. Ultrasound shows large ovaries with free fluid. What is the MOST appropriate management?

• A Proceed with hCG trigger and IUI as planned
• B Administer GnRH agonist trigger instead of hCG to reduce severity
• C Perform oocyte retrieval immediately to prevent worsening
• D Cancel the cycle, withhold hCG trigger, and manage OHSS ✓

Explanation

This patient presents with moderate-to-severe ovarian hyperstimulation syndrome (OHSS) — a potentially life-threatening complication of ovarian stimulation. The development of OHSS with multiple large follicles and ascites in a clomiphene/IUI cycle requires cancellation of the cycle and withholding the hCG trigger (which would significantly worsen OHSS). Management is supportive (hydration, albumin, thromboprophylaxis for severe cases). GnRH agonist trigger is an option in IVF cycles with GnRH antagonist protocols, not applicable here (clomiphene cycle).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.