Ovarian Hyperstimulation and Maternal Virilisation with Successful Pregnancy Outcome: A case report

Hyperreactio luteinalis (HL) and ovarian hyperstimulation syndrome during pregnancy are both benign conditions where the ovaries are enlarged with presence of multiple thin-walled cysts. The differential diagnosis is ovarian malignancy. Hyperandrogenism with resultant maternal virilisation could be seen in some cases of HL as well as in androgen secreting tumours. We report a 41-year-old female patient who underwent ovulation induction due to secondary infertility at a high-risk pregnancy unit in Muscat, Oman, in 2022. She had recurrent hospital admission with abdominal pain and large multicystic enlargement of both ovaries. She developed virilisation features by 35 weeks of pregnancy. Lower segment caesarean section was done at 36 weeks gestation for breech presentation with intra-uterine growth restriction. Magnetic resonance imaging confirmed the benign nature of the cysts. Ovarian cysts and hyperandrogenism gradually resolved 3-months post-delivery. Awareness, judicious imaging and close monitoring in such cases can result in live birth and avoid oophorectomies.