Woman, 23, Dies on Operating Table During IVF Procedure in Rare Event

• A woman died during an IVF procedure from a severe case of a condition called ovarian hyperstimulation syndrome.
• OHSS can occur if IVF drugs overstimulate the ovaries, releasing chemicals that make blood vessels leak.
• According to a report, the unnamed woman was “healthy” before she had the procedure.

A 23-year-old woman died on the operating table during a routine in vitro fertilization (IVF) procedure after a rare complication caused fluid to build up in her lungs and she stopped breathing.

Ovarian hyperstimulation syndrome (OHSS) occurs when IVF drugs that help eggs to grow overstimulate the ovaries, which releases chemicals. Those chemicals cause fluid to leak out of blood vessels into the abdomen, as well as the space around the heart and in the lungs in severe cases. It generally develops in the week after the drugs are used, but it can take longer.

Mild OHSS, which causes symptoms like abdominal swelling, discomfort, and nausea, is relatively common, affecting 33% of women having IVF, according to the Royal College of Obstetricians and Gynaecologists. Symptoms usually get better without treatment within seven to 10 days, RCOG states. 

However, just over 1% of women undergoing IVF will develop moderate or severe OHSS, according to RCOG. Symptoms include extreme thirst and signs of dehydration like dark urine, and difficulty breathing if there’s fluid in the lungs. Blood clots in the legs or lungs, which may cause a swollen, tender leg or chest pain and breathlessness, are a rare complication of severe OHSS.

The woman appeared to be ‘healthy’ before the IVF procedure 

In the case of the unnamed woman who died, a physical examination and blood tests results before a procedure to retrieve her eggs indicated she was a “healthy, young woman,” health professionals from New Delhi, India, wrote in a report in a medical journal, Autopsy and Case Reports. She had a healthy 4-year-old daughter who was born without IVF, they said.

People with polycystic ovary syndrome (PCOS), those younger than 30, people who have had OHSS previously, and those who get pregnant in the same cycle as they get OHSS symptoms, like abdominal pain and vomiting, are at increased risk of severe OHSS, which requires hospital treatment and specialist care, according to RCOG. 

It’s not clear why she developed the complication, but her young age and high levels of a type of estrogen in her blood may have contributed, the case report authors wrote. 

The woman had a cardiac arrest due to OHSS 

They described how after doctors picked up an egg from the woman’s right ovary, her blood pressure dropped, heart rate slowed, and her oxygen levels became low, so they abandoned the procedure.

When they couldn’t find a heart beat, they tried to resuscitate the woman. She had a cardiac arrest and died on the operating table because fluid built up in her lungs and she stopped breathing. 

People undergoing egg removal for IVF “should be adequately counseled about the risks related to egg donation,” the case report authors wrote.  

Dying from OHSS is ‘vanishingly rare’

Sarah Norcross, director of the fertility charity Progress Educational Trust (PET), told MailOnline that the risk of  dying from OHSS is “vanishingly rare.” 

Research suggests that complications of egg removal, including OHSS, can happen while the egg is being removed or afterwards. Other complications can include: an infection, blood in the urine, and ovarian torsion — when an ovary twists around its ligaments, cutting off its own blood supply.