Review Question - QID 210997

A 27-year-old G2P0A2 woman comes to the office with light vaginal spotting. She received a suction curettage 2 weeks ago for an empty gestational sac. Pathology reports showed hyperplastic and hydropic trophoblastic villi, but no fetal tissue. The patient denies fever, abdominal pain, dysuria, dyspareunia, or abnormal vaginal discharge. She has no chronic medical conditions. Her periods are normally regular and last 3-4 days. One year ago, she had an ectopic pregnancy that was treated with methotrexate. She has a history of chlamydia and gonorrhea that was treated 5 years ago with azithromycin and ceftriaxone. Her temperature is 98°F (36.7°C), blood pressure is 125/71 mmHg, pulse is 82/min, respirations are 12/min, and oxygen saturation is 98% on room air. On examination, hair is present on the upper lip, chin, and forearms. A pelvic examination reveals a non-tender, 6-week-sized uterus and bilateral adnexal masses. There is scant dark blood in the vaginal vault on speculum exam. A quantitative beta-hCG is 101,005 mIU/mL. Two weeks ago, her beta-hCG was 63,200 mIU/mL. A pelvic ultrasound shows bilaterally enlarged ovaries with multiple thin-walled cysts between 2-3 cm in size. Which of the following is the most likely cause of the patient’s adnexal masses?