<prompt> A patient treated for infertility with clomiphene citrate presents with sudden onset of abdominal pain and distension with ascites, the probable cause is -Uterine ruptureEctopic pregnancy ruptureMultifetal pregnancyHyperstimulation syndrome  <response>: Ans. is d Hyperstimulation syndrome Ref : Shaws 13e, p 304, 305 12the, p. 242. History of clomiphene citrate intake and the presence of ascites abdominal pain and distension strongly suggests ovarian hyperstimulation syndrome.Hyperstimulation syndrome results from clomiphene citrate intake.Other drugs which cause hyperstimulation syndrome:FSHLH therapy most commonly seen with this.GnRHCF of hyperstimulation syndromeAscites, hydrothoraxGastrointestinal abdominal pain, distension.Cerebrovascular accidentsRenal failureTorsion and hemorrhage in ovarian cyst.CoagulopathyLiver dysfunctionIt must be fairly obvious to you by now why I opted for hyperstimulation syndrome.Now lets see other options.Multifetal pregnancy - Clomiphene administration causes multiple pregnancy in about 10 cases. But the symptoms and signs of multiple pregnancy are altogether different from that of the patient.Ectopic Pregnancy - Its not mentioned anywhere that clomiphene administration causes ectopic pregnancy.Uterine rupture- Clomiphene administration has no effect on uterus. . 