Concomitant Common Femoral Deep Vein Thrombosis, Pulmunary Embolus and Bilateral Tubo-Ovarian Abscesses Following IVF Treatment in a Patient with a Fibroid Uterus and Bilateral Endometriomas

Study Objective: Educational. Design: Case report. Setting: Community Hospital. Patients: A 44 year-old patient presented 3 weeks following IVF treatment with nausea, vomiting, diarrhea, fever and abdominal pain radiating to her right shoulder. She was tachycardic, tachypneic, with diffuse abdominal tenderness and bilateral leg edema. Her pelvic exam revealed a large fibroid uterus. An elevated white count and negative BHCG were noted. Prior to the initiation of two unsuccessful IVF cycles, the patient was diagnosed with a large posterior fibroid and bilateral ovarian masses suspicious for endometriomas. The patient declined surgical treatment. Her fertility workup revealed an FSH of 6.6 and AMH of 1.8. Four embryos were transferred on each IVF cycle. Upon presentation a pelvic CT scan confirmed large, bilateral, complex adnexal masses with a posterior subserosal fibroid and a small amount of ascites. An MRI revealed a complex rim-enhancing fluid collection within the adnexal masses bilaterally suggestive of a tubo-ovarian abscess. On Ultrasound doppler she was found to have a right common femoral vein thrombosis. A spiral CT angiogram revealed a right pulmonary embolus. Treatment was initiated with subcutaneous Lovenox and IV antibiotics. Transvaginal drainage of the adnexal masses was performed. The fluid cultures demonstrated E. coli. As the patient improved clinically, the drains were removed and she was discharged home 17 days after admission with Coumadin and IV antibiotics. A month later, the patient was readmitted with fever and abdominal pain. An IVC filter was inserted with subsequent bilateral salpingectomy and a 10 cm left ovarian abscess resection. Due to the patients' desire to maximize her fertility, the right ovary and uterus were left intact. Six months later the IVC filter was removed and Coumadin stopped. The patient expressed interest in conceiving using her partner's sperm and a donor egg. Intervention: N/A Measurements and Main Results: N/A Conclusion: This case emphasizes the importance of patient selection and counseling prior to initiation of IVF treatment.