Neurological Complications Associated with Assisted Reproductive Technology – a Case Report

Czech version

Authors: I. Okáčová ¹; Y. Benešová ¹; P. Štouračihash2 ^{1,2 1,2}
Authors‘ workplace: Neurologická klinika LF MU a FN Brno ¹; CEITEC – Středoevropský technologický institut MU, Brno ²; Radiologická klinika LF MU a FN Brno ³
Published in: Cesk Slov Neurol N 2012; 75/108(5): 637-640
Category: Case Report

Overview

Assisted reproductive techniques using hormonal ovarian hyperstimulation and intended induction of ovulation are the most important scientific and therapeutic discoveries in the treatment of sterility made over the last decades. This treatment is associated with a risk of a varied degree ovarian hyperstimulation syndrome. The aim of this review is to emphasize some neurological complications possibly resulting from ovarian stimulation. Cerebral strokes are the most important complications of ovarian stimulation. We present a case of ischemic stroke after a controlled ovarian hyperstimulation regimen in a previously healthy 27-year-old woman. An increased rate and intensity of headaches, mostly in patients with chronic migraine, is another neurological complication. In the second case report, we present a 35-year-old woman suffering from complicated migraine developed after ovarian stimulation. Treatment-induced hormonal fluctuation may have negative effect on the activity and susceptibility to autoimmune diseases, such as multiple sclerosis. In the third case report, we present a 37-year-old patient with the first attack of multiple sclerosis after ovarian stimulation.

Key words:
assisted reproductive technology – ovarian hyperstimulation syndrome – neurological complications

Sources

1. Crha I. Farmakoterapie v reprodukční medicíně. Prakt Lekaren 2010; 6(4): 173–176.

2. Marek D, Machač S. Ovariální hyperstimulační syndrom-soubor interních komplikací u gynekologických pacientek podstupujících in vitro fertilizaci. Interni Med 2003; 8: 389–394.

3. Chen CD, Wu MY, Chao KH, Lien YR, Chen SU, Yang YS. Update on management of ovarian hyperstimulation syndrome. Taiwan J Obstet Gynecol 2011; 50(1): 2–10.

4. Delvigne A, Demoulin A, Smitz J. The ovarian hyperstimulation syndrome in vitro fertilization: a Belgian multicentric study. Hum Reprod 1993; 8(9): 1353–1360.

5. Mardešič T. Hyperstimulační syndrom, klasifikace, patofyziologie, prevence a léčba. Cesk Gynekol 1993; 58(1): 23–26.

6. Latová H, Bednařík J. Ischemický iktus jako komplikace ovariálního hyperstimulačního syndromu – kazuistika. Cesk Slov Neurol N 2008; 71/104 (Suppl 3): S128.

7. Elchalal U, Schenker JG. The pathophysiology of ovarian hyperstimulation syndrome – views and ideas. Hum Rep 1997; 12(6): 1129–1137.

8. Qazi A, Ahmed AN, Qazi MP, Usman F, Ahmad A. Ischemic stroke with ovarian hyperstimulation syndrome. J Pak Med Assoc 2008; 58(7): 411–413.

9. Hwang WJ, Lai ML, Hsu CC, Hou NT. Ischemic stroke in a young woman with ovarian hyperstimulation syndrome. J Formos Med Assoc 1998; 97(7): 503–506.

10. Bártková A, Sanak D, Dostál J. Acute ischaemic stroke in pregnancy: a severe complication of ovarian hyperstimulation syndrome. Neurol Sci 2008; 29(6): 463–466.

11. Man BL, Hui ACF. Cerebral venous thrombosis secondary to ovarian hyperstimulation syndrome. Hong Kong Med J 2011; 17(2): 155–156.

12. Worrell GA, Wijdicks EFM, Eggers MD. Ovarian hyperstimulation syndrome with ischemic stroke due to an intracardiac trombus. Neur Sci 2008; 29(6): 463–466.

13. Koo EJ, Rha JH, Lee BI, Kim MO, Ha CK. A case of cerebral infarct in combined antiphospholipid antibody and ovarian hyperstimulation syndrome. J Korean Med Sci 2002; 17(4): 574–576.

14. Tate J, Bushnell C. Pregnancy and stroke risk in women. Womens Health (Lond Engl) 2011; 7(3): 363–374.

15. Johnson D, Kramer D, Cohen E, Rochon M, Rosner M, Weinberger J. Trombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator. Stroke 2005; 36(6): E53–E55.

16. Keller O, Linhartová A. Některá další neurologická onemocnění a jejich léčba v graviditě a laktaci. Neurol Prax 2010; 11(5): 300–302.

17. Amir BY, Yaacov B, Guy B, Gad P, Itzhak W, Gal I. Headaches in women undergoing in vitro fertilization and embryo-transfer treatment. Headache 2005; 45(3): 215–219.

18. Rollene NL, Khan Z, Schroeder DR, Cutrer FM, Coddington CC. Migraines and ovarian hyperstimulation syndrome: a dopamine connection. Fertil Steril 2011; 95(1): 417–419.

19. Cutolo M, Sulli A, Capellino S. Sex hormones influence on the immune system: basic and clinical aspects in autoimmunity. Lupus 2004; 13(9): 635–638.

20. Orton SM, Herrera BM, Yee IM, Valdar W, Ramagopalan SV, Sadovnick AD et al. Canadian Collaborative Study Group. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006; 5(11): 932–936.

21. Nicot A. Gender and sex hormones in multiple sclerosis pathology and therapy. Front Biosci 2009; 14: 4477–4515.

22. Ebers G. Environmental factors in multiple sclerosis. MS Forum 1998; Modern Management Workshop, Montréal.

23. Laplaud DA, Lefrère F, Leray E, Barrière P, Wiertlewski S. Increased risk of relapse in multiple sclerosis patients after ovarian stimulation for in vitro fertilization. Gynecol Obstet Fertil 2007; 35(10): 1047–1050.