Massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction

Objective: To present an atypical case of massive ascites and hydrothorax after leuprolide acetate administration in a down-regulated woman undergoing assisted reproduction. Design: Case report. Setting: Centre for Reproductive Medicine, Department of Obstetrics, Gynaecology, and Neonatology, University of Parma, Parma, Italy. Patient(s): A 41-year-old, nulliparous, white woman who developed massive ascites and hydrothorax after administration of 0.50 mg/day of subcutaneous leuprolide acetate, beginning at the midluteal phase. Intervention(s): Down-regulation with the gonadotropin-releasing hormone analogue was discontinued, and therapy was started with furosemide 50 mg/day for 10 days. Main Outcome Measure(s): Successful medical reduction of ascites and hydrothorax. Result(s): Resolution of symptoms. Conclusion(s): A comprehensive MEDLINE search revealed this to be the first reported case of massive ascites and hydrothorax after leuprolide acetate administration (0.5 mg daily) in a down-regulated woman undergoing assisted reproduction. This case can be explained by an increase in capillary permeability, which resulted in a rapid fluid shift from the intravascular space into the third space. We believe that ascites in our patient resulted from an increase in estradiol in the ovaries, due to a direct action of the gonadotropin-releasing hormone analogue on the corresponding ovarian receptors in the first few days after the start of therapy.