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

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.

Fig. 1

Ultrasonography showing mild ascites 2 days after oocyte retrieval

Fig. 2

Ovarian ultrasonography showing mild ovarian swelling 2 days after oocyte retrieval

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

Intraoperative findings. Left: ruptured ovary; right: blood pooling in the pelvic cavity

Fig. 5

Ovarian ultrasonography before discharge, showing bilateral shrinkage of the ovarian swelling to ~ 4.5 cm size