INTERNAL JUGULAR-VEIN THROMBOSIS CAUSED BY RESISTANCE TO ACTIVATED PROTEIN-C AS A COMPLICATION OF OVARIAN HYPERSTIMULATION AFTER IN-VITRO FERTILIZATION

We present a case of a 24 year old woman who became pregnant (twins) a fter human menopausal gonadotrophin (HMG)-induced ovarian stimulation, in-vitro fertilization (IVF) and subsequent embryo transfer. She deve loped a right internal jugular vein thrombosis as a complication of se vere ovarian hyperstimulation syndrome (OHSS) 28 days after embryo tra nsfer, The thrombosis developed in spite of anticoagulation with low-d ose heparin. Later a resistance to activated protein C (APC) or Dahlba ck disease was diagnosed. Due to a new test procedure (accelerin inact ivation test), the diagnosis was possible even under anticoagulation t reatment. The coincidence of hyperstimulation and internal jugular vei n thrombosis with the concurrent diagnosis of resistance to APC has no t been published previously. The benefit of general screening for resi stance to APC before admission to the IVF programme should be weighed. Targeted selection of a group of high-risk women would therefore be m ade possible.