Article Text

Download PDFPDF
Rare case of obstetric cholestasis presenting in the first trimester following in vitro fertilisation
  1. Krystal Koh1,
  2. Rajeswari Kathirvel1,2 and
  3. Manisha Mathur1,2
  1. 1Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
  2. 2NUS Yong Loo Lin School of Medicine, Singapore
  1. Correspondence to Dr Krystal Koh; krystalgermaine{at}


Intrahepatic cholestasis of pregnancy (ICP) generally presents in the third trimester with pruritus without a rash, characterised by elevated bile acids, with or without transaminitis and hyperbilirubinaemia. Risk factors include a family history of cholestasis, South Asian ethnicity, multifetal gestation, in vitro fertilisation (IVF) and history of hepatitis or biliary disorders.

IVF involves the use of high dose gonadotropin stimulation and human chorionic gonadotropin trigger. High doses of progesterone supplementation are additionally given after embryo transfer. The increase in oestrogen and progesterone levels early on in the pregnancy is a possible explanation for the development of ICP in IVF pregnancies at earlier gestations.

We present a rare case of iatrogenic ICP presenting in the first trimester in a pregnancy conceived by IVF. Unlike other cases reported, our patient did not have recurrence of ICP in the third trimester, and also had no history of ICP in her first pregnancy.

  • reproductive medicine
  • obstetrics and gynaecology
  • liver disease

Statistics from


  • Contributors KK summarised the case records and wrote the paper. MM managed the case presented, and both MM and RK supervised and contributed to writing the paper. All authors commented on the final paper and have approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.