Received February 22, 2021
Accepted August 19, 2021

Ovarian hyperstimulation syndrome (OHSS) is an inseparable entity associated with controlled ovarian stimulation(COS) in assisted reproduction. It presents a great challenge to the clinician for timely diagnosis and intervention as it is a life-threatening condition. We came across such a rare case of late onset severe OHSS which lasted till 19 weeks period of gestation(POG) with diagnostic challenge in which patient had hemorrhagic ascites post embryo transfer and transaminitis. The case was managed effectively with repeated paracentesis along with replacement therapy and the transaminitis was also gradually resolved. Severe OHSS can follow an unusually prolonged course and may be associated with transaminitis. Our case suggests, it is crucial to distinguish between the nature and etiology of transaminitis along with OHSS pathology, other pathologies like drug induced transaminitis should also be kept in mind.