A 26-year-old woman with PCOS is undergoing IVF. She develops abdominal distension, nausea, and dyspnea 5 days after oocyte retrieval. Ultrasound shows bilateral ovarian enlargement to 10 cm with ascites. Her hematocrit is 48%. The MOST important immediate intervention is:
- A Cryopreserve all embryos and administer IV albumin 20% with IV fluids ✓
- B Proceed with fresh embryo transfer to resolve the condition more quickly
- C Administer hCG trigger for oocyte release
- D Perform laparoscopic drainage of ovarian cysts
Correct answer: A. Cryopreserve all embryos and administer IV albumin 20% with IV fluids
Explanation
This presentation is severe OHSS (ovarian hyperstimulation syndrome) — bilateral ovarian enlargement >10 cm with ascites and hemoconcentration (hematocrit ≥45% indicates hemoconcentration and thrombosis risk). Management includes IV albumin (expands intravascular volume, binds VEGF), IV crystalloid hydration, heparin prophylaxis, and withholding embryo transfer (freeze-all strategy) as exogenous progesterone/fresh embryo transfer would prolong OHSS via endogenous hCG. Fresh transfer must be avoided.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.