ABSTRACT
OBJECTIVE: To describe a patient who developed severe ovarian hyperstimulation syndrome (OHSS) with uncharacteristic features after recent COVID-19 infection. MATERIALS AND METHODS: A patient with prior mild COVID-19 developed an atypical case of OHSS with significant bilateral pleural effusions requiring bilateral thoracentesis and only minimal abdominal ascites. Isolated pleural effusions without significant ascites in not frequently found in patients with OHSS, with only one case with an effusion requiring a thoracentesis in 771 patients in a 1995 Canadian study. COVID-19 is known to cause inflammatory responses in the lung, however, pleural effusions are a rare symptom and usually only in those with severe disease. Long-standing damage from COVID-19, or ''post-COVID conditions'' is still under active investigation but can occur in patients even with mild disease. RESULTS: A 25yo G0 (BMI 27, AMH 9) without significant past medical or surgical history underwent IVF due to male factor infertility and polycystic ovarian syndrome (PCOS). She was diagnosed with COVID-19 5 weeks prior to stimulation and reported a mild course not requiring hospitalization. She underwent a long agonist protocol with a peak E2 of 6700 on day of HCG trigger (5000u) and had 42 oocytes retrieved. On POD #3, she presented with abdominal pain with distension and shortness of breath. A therapeutic paracentesis was performed with 500 ml drained and minimal improvement of symptoms. Due to significant response, she had a freeze all embryo cycle. On POD #5, she had worsening shortness of breath and underwent a CT pulmonary embolism (PE) protocol which did not demonstrate a PE but did show significant bilateral pleural effusions without abdominal ascites. She then underwent a bilateral thoracentesis with 800 ml drained from left lung and 1000 ml drained from right lung. She had significant improvement and returned to baseline after two days. CONCLUSIONS: OHSS is an uncommon side effect of gonadotropin stimulation, but this patient had multiple risk factors including age, PCOS diagnosis, AMH level, peak E2 level and number of oocytes retrieved. Ascites typically appears before pleural effusions. We postulate that the recent COVID-19 infection may have increased fluid accumulation preferentially to the lungs rather than the abdomen. IMPACT STATEMENT: With the ever increasing knowledge of post- COVID conditions, one must consider its potential long-term sequalae. Unexpected or atypical presentations may be due to COVID-19. The physiologic changes that occur with fertility treatment may be exacerbated by recent, even mild, COVID-19 illness.
ABSTRACT
OBJECTIVE: Due to the COVID-19 pandemic, video-based telemedicine visits have become the standard in many clinical practices. Many reproductive endocrinology consultations do not require a physical exam, allowing for integration of telemedicine. The purpose of this study is to evaluate patient satisfaction with telemedicine visits in the Reproductive Endocrinology and Infertility (REI) office. MATERIALS AND METHODS: This is a prospective cross-sectional study that includes any person undergoing a new patient visit at Washington University's Reproductive Endocrinology clinic from March 1st-April 20th 2021. After the visit, patients were contacted via telephone to obtain consent to participate in an online one-time research survey. A link was sent to their email with the survey through RedCap secure web application. The survey is 25 questions which includes the telehealth usability questionnaire (TUQ) survey, a previously published tool to evaluate usability and quality of telehealth interaction, along with questions specific to the REI clinic and the participation of learners during visits. Baseline patient demographics including age, race/ethnicity, BMI, distance from clinic, and recommended treatment were collected. RESULTS: 117 participants were contacted, 78% (n=91) agreed to participate in the study, and 45% (n=41) completed the survey. There were no significant differences in age, BMI, distance from clinic or length of infertility with response to survey. 92.5% responders would use telemedicine services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 82.5% and travel time for 95%. The mean distance from clinic was 76 miles, and there was no significance difference in satisfaction with telemedicine services (p=0.46) or perceived access to healthcare services (p= 0.43) between those living closer or further than 76 miles. Those living further also had no preference for telemedicine visits over in person visits (p=0.134). CONCLUSIONS: In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telemedicine services. Based on our survey, majority of patients were satisfied with telemedicine visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telemedicine depending on their distance from clinic, this finding is reassuring because patients are satisfied with telemedicine for reasons other than distance from clinic. IMPACT STATEMENT: Patient satisfaction surveys demonstrate the feasibility of using telemedicine services for new-patient visits to provide quality care to patients who perceive telemedicine similar to in-person visits. Given the wide acceptance of telemedicine, reimbursement by insurance companies should continue when the pandemic is over.