Pregnancy with 15 live fetuses and severe ovarian hyperstimulation syndrome after ovulation induction and intrauterine insemination.

The empirical use of ovulation induction and intrauterine insemination for male factor infertility, unexplained infertility, and anovulatory infertility can be associated with multiple gestation and ovarian hyperstimulation syndrome (OHSS). A 30-year-old lady was referred for fetal reduction of very high-order pregnancy. She became pregnant after ovulation induction and artificial insemination. The stimulation protocol included clomiphene citrate and fixed-dose gonadotropins. Triggering of ovulation was done with 5,000 units of human chorionic gonadotropins (hCG). Cycle monitoring was done with ultrasonography only. The patient was admitted to the hospital due to severe OHSS. Physical examination revealed that the uterus size was equivalent to 28 weeks gestation. Transvaginal ultrasonography (TVUS) and pelvic magnetic resonance imaging (MRI) showed 15 intrauterine gestational sacs with viable eight-week fetuses and 7 cm x 4.5 cm fluid collection. Both ovaries were enlarged. The right ovary was 12 cm x 5 cm and the left ovary was 10 cm x 6.5 cm. The patient had a spontaneous miscarriage of the 15 fetuses.