Excessive

A 25 year old nulliparous woman presents with nausea, lower abdominal pain, and progressive abdominal distension for 1 week. She is otherwise asymptomatic.

Her gynecological history is significant for primary infertility for 2 years. She was started on ovulation induction therapy with clomiphene citrate on the 3rd day of her last regular menstrual period, which was 3 weeks ago.

She is not on any other medications, and her medical, surgical, and family histories are unremarkable. There is no history of promiscuity.

Select Relevant Investigations
Urine hCG Test

Performed

The Urine hCG test is positive.
Ultrasound Abdomen

Performed

Both ovaries show multiple small cysts ranging from 2 to 6 mm in size. The right ovary is grossly enlarged, measuring 12.8 × 8 cm, while the left ovary is normal in size.

The uterus is normal in size and appears empty. There is a large amount of free fluid in the peritoneal cavity.

The other intra-abdominal organs are sonographically normal.
Comprehensive Metabolic Panel

Performed

Random Plasma Glucose: within normal parameters
Serum Electrolytes: within normal parameters
Renal Profile and Liver Profile: no abnormalities
Full Blood Count

Performed

WBC: 9,600/mm3 (4,000-11,000)
N:59% L:35%
Hb: 12.1 g/dL (11.5-13.5)
PCV (Hct): 37% (35-47)
Platelets: 190,000 (150,000-400,000)

Select Relevant Management
IV Fluids
Strict Bed Rest
Paracentesis
Laparoscopy