Should we sacrifice everything for a child?

Introduction: Our department often provides hepatology consultation in the case of patients who are treated on other wards and have abnormal liver functions. The responsibility of the hepatologist is increased if the patient is an expectant woman. In this case study, we present a pregnant woman with drug induced progressive ovarian hyperstimulation syndrome and toxic hepatitis.

Case study: The 33-year old woman had been investigated with infertility over a decade when she underwent preliminary hormon therapy (gonadotropin) followed by in vitro fertilisation and embrio transfer. As the side effect of the hormon therapy, she developed severe ovarian hyperstimulation syndrome with ovaries measuring 7–8cm in diameter. She was eventually admitted to intensive care with breathing insufficiency due to peripheric oedema, hydrothorax and ascites where she started to show moderately elevated levels of liver function enzymes. She received albumin and fluid replacement therapies and intermittent abdominal drainage. Although her complaints ceased and the overall clinical picture improved, her liver functions further deteriorated which could not be explained with the earlier HCG therapy. As serological, bacterial and other laboratory tests also excluded hepatitis with infectious or immunological origin, we assumed a progesteron (which she received to help maintaining a potential pregnancy) induced toxic hepatitis as the underlying cause and initiated the reduction of the dose of the drug. Her continuously improving liver status supported our diagnosis and treatment. Her progesteron treatment was eventually stopped by our obstetrician colleagues and the woman was discharged with an alive pregnancy and close to normal liver functions. Unfortunately, she lost the baby between discharge and the following check-up. Discussion: It is very important to pay increased attention to the general health of women who undergo fertility treatments. The liver functions of all women planned to receive hormon therapy should be checked beforehand to help the timely diagnosis and treatment of any potential consequent liver damage.