Cerebral venous sinus thrombosis after in-vitro fertilization and embryo transfer:a case report and review of the literature

Objective:To improve the diagnosis and treatment of intracranial thrombosis after in-vitro fertilization and embryo transfer (IVF-ET) cycles in clinical practice. Methods: The clinical data regarding a case of intracranial sinus thrombosis in IVF-ET were reviewed. Clinical characteristics, prevention and treatment of intracranial thrombosis in IVF-ET were discussed in review of literature. Results: A woman with secondary infertility underwent an IVF cycle with long protocol controlled ovarian hyperstimulation. The oestradial concentration was 7083 pmol/L on the day of human chorionic gonadotrophin (hCG). Eighteen oocytes were retrieved and 3 embryos were transferred. Forteen days after ovum pickup, the patient had ascites and the pregnancy test was positive. Two days later, she presented with progressive headache and neck pain. And two more days later, she developed a sudden coma and left hemiparesis. Magnetic resonance image (MRI) showed multiple infarct lesions on the left prefrontal cortex and on the right temporal lobe,and magnetic resonance venography (MRV) showed extensive thrombosis in the superior sagittal, the right transverse and sigmoid sinus. Pregnancy was terminated and low-weight-molecular heparin (LWMH) was used. After 8 weeks, she recovered with only fine sense defect on the back of left hand. Literatures were also reviewed and the manifestations, relevant causing factors and the methods of prevention and treatment of intracranial thrombosis were discussed after ovarian hyperstimulation and IVF-ET. Conclusion: The complication of intracranial thrombosis in IVF-ET is rare and life-threatening,and may cause neurological sequelae after treatment. Prevention of OHSS may reduce its incidence. Any pain in head or neck and neurologic symptoms following IVF-ET should be watched closely to exclude the possible cerebrovascular thrombosis. Early diagnosis is important for successful treatment. Anticoagulation therapy with LWMH can serve as a major therapy.