Ovarian Hyperstimulation secondary to clomiphene citrate resulting in ovarian torsion: A rare report

Ovarian hyperstimulation syndrome (OHSS) is a potentially severe complication of ovulation induction. Although less common than with gonadotropin treatment, OHSS can occur secondary to an excessive dose of clomiphene citrate, a first-line ovulation induction agent. A serious complication of OHSS is ovarian torsion, which demands prompt diagnosis and intervention to prevent permanent damage. This case report highlights a rare case of severe ovarian hyperstimulation syndrome (OHSS) with subsequent ovarian torsion following clomiphene citrate treatment.

A 24-year-old woman with primary infertility developed severe OHSS after receiving clomiphene citrate (100 mg twice daily, D2-D16). Her initial symptoms included vomiting and severe abdominal pain. Ultrasound examination revealed an enlarged left ovary (100x65x60mm) with multiple follicles and pelvic effusion. Despite initial conservative management, the patient returned four days post-discharge with worsening symptoms. Emergency laparoscopy revealed vascular congestion of the left ovary and successful detorsion restored normal blood flow.

this case illustrates severe OHSS complicated by ovarian torsion secondary to an excessive dose of clomiphene citrate. The patient's initial presentation and ultrasound findings were indicative of OHSS, and despite conservative management, progression to ovarian torsion required surgical intervention. The successful detorsion and restoration of blood flow underscore the importance of timely surgical management to prevent irreversible damage, regardless of the ovulation induction agent used.

Although clomiphene citrate is generally considered safer than gonadotropins for ovulation induction, it can still induce severe OHSS leading to complications such as ovarian torsion particularly if given in overdosage. This case emphasizes the critical need for vigilant monitoring and prompt surgical intervention in OHSS cases to preserve ovarian function, regardless of the ovulation induction agent used.