Case report Bilateral internal jugular venous thrombosis following successful assisted conception in the absence of ovarian hyperstimulation syndrome Ulun Ulug, Esra Aksoy, Halit Erden, Numan Bayazit, Mustafa Bahc ¸eci * Bahc¸eci Women’s Health Care Center and German Hospital at Istanbul, Istanbul, Turkey Received 27 May 2002; received in revised form 23 October 2002; accepted 14 November 2002 Abstract The majority of the venous thromboembolic events seen in patient following gonadotropin administration were associated with the development of ovarian hyperstimulation syndrome (OHSS). However, in this case report, a 29-year-old woman that conceived by controlled ovarian hyperstimulation, intracytoplasmic sperm injection and subsequent embryo transfer without conjunction of OHSS was described. Bilateral jugular venous thrombi were detected by duplex Doppler in the 8th week of pregnancy when she was admitted to the emergency room for difficulty in swallowing and bilateral neck pain. She had unremarkable history and negative results for thrombophilia screening. Full anticoagulation with intravenous heparin was initiated and continued subcutaneously throughout pregnancy. She delivered two healthy babies at 36 weeks of pregnancy. Venous thromboembolism should be taken in account in patients undergoing gonadotropin administration for assisted conception with the complaint of extremity pain regardless of having risk factors for thromboembolism. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Gonadotrophins; Thromboembolism; Assisted conception 1. Introduction Assisted reproductive technology treatments (ART) offer relatively safe procedures to infertile couples [1,2]. How- ever, they still pose some risks with morbidity and rarely, mortality [3,4]. The introduction of gonadotrophin releasing hormone (GnRH) analogues has allowed the flexibility in administration of gonadotropins to patients who have under- gone controlled ovarian hyperstimulation (COH) for ART. However, it should be noted that, this may paradoxically induce the development of ovarian hyperstimulation syn- drome (OHSS), with its severe and life threatening forms [5]. Basically, OHSS is characterized by ovarian enlargement, weight gain, abdominal distension, generalized edema, ascites and hydrothorax. In some cases, venous thromboem- bolism may also complicate this clinical picture. Since ART became widely practiced method, more cases of venous thromboembolism have been presented, in patients under- going COH [6–8]. In the majority of those cases, the throm- boembolic events have commenced immediately consequent to or within several weeks of the development of full blown severe OHSS [9]. In this regard, the case report herein is unique because it presents bilateral jugular vein thrombosis developed in a patient following successful assisted concep- tion, but without any clinical evidence of OHSS. 2. Case report A 29-year-old woman was admitted to our center for IVF, for the treatment of primary infertility due to male factor. Her initial physical examination was within normal limits. She was a non-smoker and neither the patient’s nor the family history was remarkable for any thromboembolic events. Ovarian down regulation was initiated with daily leuprolide acetate 1 mg (Lucrin, Abbott, France), beginning on the 21st day of preceding menstruation. COH was induced by highly purified folliculotropin 225 IU per day (Metrodin HP, Serono, Aubonne, Switzerland), beginning after the verification of ovarian quiecence. After 11 days of stimulation, 15 follicles, larger than 14 mm were observed concomitantly with serum estradiol (E 2 ) level of 2502 pg/ ml. Intramuscular 10,000 IU hCG (Pregnyl, Organon, Oss, The Netherlands) was then injected to induce follicular maturation. Nineteen oocytes were retrieved transvaginaly European Journal of Obstetrics & Gynecology and Reproductive Biology 109 (2003) 231–233 * Corresponding author. Present address. Abdi Ipekci Cad No. 44 Azer Is Merkezi Kat 6 D 17, 80200 Nisantasi, Istanbul, Turkey. Tel.: þ90-212-230-0809; fax: þ90-212-230-3990. E-mail address: mbahceci@hotmail.com (M. Bahc ¸eci). 0301-2115/02/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0301-2115(02)00511-0