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Case Reports
. 2021 Jun 27;15(1):327.
doi: 10.1186/s13256-021-02938-8.

Severe hemoperitoneum resulting from restart of letrozole after oocyte retrieval procedure: a case report

Haipeng Huang  1 , Yasushi Takai  2 , Kouki Samejima  2 , Yosuke Gomi  2 , Tatsuya Narita  2 , Shunichiro Ichinose  2 , Yukiko Itaya  2 , Yosihisa Ono  2 , Sigetaka Matsunaga  2 , Masahiro Saitoh  2 , Hiroyuki Seki  2
Affiliations
Case Reports

Severe hemoperitoneum resulting from restart of letrozole after oocyte retrieval procedure: a case report

Haipeng Huang et al. J Med Case Rep. .

Abstract

Background: In the field of oncofertility, patients with breast cancer are often administered letrozole as an adjuvant drug before and after oocyte retrieval to prevent an increase in circulating estradiol.

Case presentation: We report a case of abdominal hemorrhage due to an ovarian rupture in a 29-year-old Japanese patient who restarted letrozole 2 days after an oocyte retrieval procedure in which 14 mature oocytes were retrieved. The patient had sought embryo cryopreservation as a fertility preservation option before undergoing treatment for recurrent breast cancer. A day after restarting letrozole treatment, the patient unexpectedly developed severe abdominal pain. Laparoscopic hemostasis was performed to manage the ovarian swelling and hemorrhage.

Conclusions: The ovaries can be restimulated by restart letrozole after an oocyte retrieval procedure. Therefore, reproductive-medicine practitioners should understand the potential complications of letrozole administration in such cases and take steps to ensure that they are minimized.

Keywords: Breast cancer; Fertility preservation; Hemoperitoneum; Laparoscopic surgery; Letrozole; Ovarian hemorrhage.

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Conflict of interest statement

HH, YT, KS, YG, TN, SI, YI, YO, SM, MS, and HS declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Ultrasonography showing mild ascites 2 days after oocyte retrieval
Fig. 2
Fig. 2
Ovarian ultrasonography showing mild ovarian swelling 2 days after oocyte retrieval
Fig. 3
Fig. 3
Ovarian ultrasonography 3 days after oocyte retrieval (1 day after restarted letrozole). The ultrasonograph shows bilateral exacerbation of ovarian swelling and increased ascitic volume
Fig. 4
Fig. 4
Intraoperative findings. Left: ruptured ovary; right: blood pooling in the pelvic cavity
Fig. 5
Fig. 5
Ovarian ultrasonography before discharge, showing bilateral shrinkage of the ovarian swelling to ~ 4.5 cm size
See this image and copyright information in PMC

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