<prompt> A 24 year old underweight woman presents to you with progressive abdominal discomfo, dyspnoea, nausea and vomiting. Abdominal examination revealed cystic enlargement of ovaries. Relevant investigations results are as follows: Hematocrit - 57 Total count - 25000 mm3 RFT -Impaired LFT - Mildly impaired USG - Massive ascites Serum peak oestradiol- 9000 pg ml X ray chest - shows pulmonary oedema History revealed that she had polycystic ovarian disease PCOD and was on treatment for infeility. She had received an injection last week from her infeility specialist. What is your diagnosis?Budd Chiari syndromeMeigs syndromeOvarian hyperstimulation syndromePseudomyxoma peritonei  <response>: Here note that the serum peak oestradiol is very high and she had received an injection as a pa of her treatment for infeility which may have been human chorionic gonadotropin. This resulted in ovarian hyperstimulation syndrome. In Budd Chiari syndrome or Meigs syndrome oestradiol need not be this high. Note that thromboembolic complication may ensue ovarian hyperstimulation syndrome. Risk factors for ovarian hyperstimulation syndrome Age35 years Asthenic habitus Pregnancy PCOS Serum oestradiol 4000 pgml Luteal phase hcg stimulation 35 follicles Ref: Oxfords Handbook of clinical specialities, 8th Edition, Page 311 