Prolonged Ovarian Hyperstimulation Syndrome in a Patient With Advanced Kidney Disease

Assisted reproductive technologies such as in vitro fertilization (IVF) have expanded fertility options for women with chronic kidney disease (CKD), a population with a high prevalence of infertility. Patients with CKD are at increased risk of complications from ovarian stimulation. Ovarian hyperstimulation syndrome (OHSS) is a potentially serious iatrogenic complication marked by increased vascular permeability, third-space fluid shifts, and increased risk of systemic complications such as acute kidney injury. We present a case of prolonged OHSS complicated by acute kidney injury, hyperkalemia and proteinuria in a patient with baseline stage 4 CKD who underwent IVF. Despite use of gonadotropin-releasing hormone antagonist protocol and a prophylactic dopamine agonist, the patient developed early-onset OHSS with ascites, elevated creatinine, hyperkalemia, and proteinuria. This case highlights the increased susceptibility of advanced patients with CKD to moderate-severe and prolonged OHSS, underscoring the need for individualized ovarian stimulation protocols, close nephrology-reproductive endocrinology collaboration, and vigilant monitoring of kidney function during and after IVF treatments.