This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
A patient treated for infertility with clomiphene citrate presents with sudden onset of abdominal pain and distension with ascites, the probable cause is: 
Select and explain. 
A. Uterine rupture, B. Ectopic pregnancy rupture, C. Multifetal pregnancy, D. Hyperstimulation syndrome
D: Hyperstimulation syndrome
Answer: D: Hyperstimulation syndrome 
Explanation: Cervical factor infertility can be due to abnormal or deficient mucus ... William Gynae 1st/ed p 460
i. Infection
ii. Prior cervical surgery
iii. Use of antiestrogens (e.g. clomiphene citrate) for ovulation induction (so clomiphene is a cause of cervical factor
infertility rather than management)
iv. Sperm antibodies
The treatment of cervical factor thus depends on the cause:
• If it is due to chronic cervicitis/infection - Treatment of infection by antibiotics is the cure.
• If is due to decreased mucus volume - Treatment includes short term supplementation with exogenous estrogen like ethinyl estradiol and use of mucolytic expectorant like guaifenesin. However, their value has not been confirmed.
• If it is due to antisperm antibodies. Treatment options include:
– Use of condom or diaphragm as a barrier method for 3 months. During this period, the antibodies will disappear and conception may occur then.
– Corticosteroids given to female partner can also help in getting rid of these antibodies.
– Intrauterine insemination at the time of ovulation (most acceptable method for cervical factor infertility) or GIFT (Gamete intrafallopian transfer) are very useful techniques in such cases.
• IUI is the best method for treating cervical factor infertility and unexplained infertility. So many clinicians forgo cervical mucus testing and proceed directly to IUI treatment in absence of tubal disease.