Renal artery dissection during an in vitro fertilization/intracytoplasmic sperm injection cycle

Objective

To describe a rare case of a renal artery dissection presenting as new-onset hypertension and severe flank pain during an IVF/intracytoplasmic sperm injection (ICSI) cycle.

Design

Case report.

Setting

Private, university-affiliated infertility clinic.

Patient(s)

A previously healthy 39-year-old woman with secondary infertility undergoing her second IVF/ICSI cycle.

Intervention(s)

Renal artery angioplasty and medical management with multiple antihypertensive agents. Institutional review board approval was not applicable and therefore not obtained.

Main Outcome Measure(s)

Control of hypertension.

Result(s)

The patient presented with severe flank pain and new-onset severe hypertension on day 5 of ovarian stimulation for IVF/ICSI. At that time her estrogen level was 685 pmol/L. An ultrasound examination showed evidence for infarction of the upper pole of the right kidney, and an angiogram revealed a right renal artery dissection. Blood pressure was eventually controlled after renal artery angioplasty and initiation of multiple antihypertensive agents.

Conclusion(s)

This is the first report of a renal artery dissection presenting during ovarian stimulation for IVF/ICSI. There were no hemodynamic or serum estrogen changes that could explain a link between the IVF process and the renal artery dissection.

Key Words: IVF, ovarian stimulation, renal artery dissection, secondary hypertension