Clinical Conundrum: Spontaneous Ovarian Hyperstimulation Syndrome

A 31-year-old African American G0 female was referred for primary infertility for 18 months. Her history was significant for irregular menstrual cycles with new onset galactorrhea and 2 previous laparoscopic bilateral ovarian cystectomies. The patient was undergoing psychotherapy for severe depression/anxiety and was treated with escitalopram (Lexapro) 20 mg and bupropion (Wellbutrin) 100 mg daily. Her physical examination was significant for bilateral breast discharge. A transvaginal ultrasound (TVS) revealed normal endo/myometrial echoes and an asymmetric enlarged left ovary measuring 75 × 59 mm with multiple cysts measuring 47, 38, 33, and 20 mm, respectively, whereas the right ovary was unremarkable.