Hyperreactio luteinalis following frozen embryo transfer managed by fetal reduction

Area of Science:

• Reproductive Endocrinology
• Maternal-Fetal Medicine
• Assisted Reproductive Technology

Background:

• Hyperreactio luteinalis (HL) is a rare, benign condition characterized by luteinization and cystic enlargement of the ovaries.
• It is often associated with conditions of increased human chorionic gonadotropin (hCG), such as multiple gestations and molar pregnancies.
• Assisted reproductive technology (ART) treatments, particularly those involving high hCG levels, are increasingly recognized as potential triggers.

Observation:

• A 27-year-old woman undergoing ART for primary infertility developed HL during a triplet pregnancy after frozen embryo transfer.
• She presented in the first trimester with significant abdominal pain and distension due to massive ovarian enlargement.
• Conservative management strategies provided no relief for her symptoms.

Findings:

• Fetal reduction from triplets to twins was performed.
• Following fetal reduction, the patient experienced significant symptomatic improvement.
• This suggests a direct correlation between the reduction in hCG levels and symptom amelioration.

Implications:

• Fetal reduction can be a viable and effective therapeutic option for managing severe hyperreactio luteinalis in multifetal pregnancies when conservative measures are insufficient.
• This case highlights the importance of considering HL in ART pregnancies presenting with unexplained abdominal symptoms and ovarian enlargement.
• Further research into the management of HL in the context of ART and multifetal gestations is warranted.