卵巢子宫内膜异位囊肿取卵术后并发盆腔脓肿和肠梗阻:病例分析1例并文献复习

目的探讨子宫内膜异位症(EMS)不孕患者助孕策略的选择,卵巢子宫内膜异位囊肿保守治疗的风险及取卵术后并发盆腔脓肿的风险与预防。方法分析1例通过卵巢子宫内膜异位囊肿取卵术后并发盆腔脓肿和肠梗阻病例并文献复习。结果 EMS不孕患者取卵后并发盆腔脓肿、盆腹腔粘连及部分小肠梗阻保守治疗失败后行手术治疗。结论 EMS不孕应综合年龄、卵巢功能、疾病严重程度及男方因素等选择最佳的助孕策略。为预防EMS取卵后感染的发生,在取卵术前要进行更彻底的阴道准备,术中规范操作避免反复穿刺阴道壁,同时避免穿刺巧克力囊肿,术后广谱抗生素预防感染。对于已合并盆腔感染患者,考虑将胚胎冷冻后择期移植。     

A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer

Tubo-ovarian abscess is an uncommon complication in pregnant women. In this report, we present a patient who developed a tubo-ovarian abscess during pregnancy following in vitro fertilization and embryo transfer (IVF-ET). Despite treatment with intravenous antibiotics she delivered at 22 weeks of gestation. After delivery, she underwent a left salpingo-oophorectomy. Review of the literature revealed only 26 reported cases of tubo-ovarian or pelvic abscess during pregnancy. Pelvic inflammatory disease, previous laparotomy, and structural genital anomalies are known risk factors for pelvic abscess during pregnancy. Pelvic abscess resulting as a complication of vaginal oocyte retrieval has been reported. Therefore, although enabling women with organic pelvic disease such as endometriosis and hydrosalpinx to achieve pregnancy, assisted reproductive techniques may potentially result in pelvic infection during pregnancy. This case suggests that a preconception evaluation and treatment for such conditions should be considered for women undergoing treatment for infertility.     

Ovarian abscess during pregnancy mimicking a leiomyoma of the uterus: A complication of transvaginal ultrasound-guided oocyte aspiration

Conclusions Ovarian abscess is a serious complication that may occur after transvaginal oocyte aspiration for IVF. Symptoms may be very mild, late, or even absent. Mechanical obstruction of the pelvic inlet may be the only sign during pregnancy. Therefore, when a pelvic mass is discovered after transvaginal oocyte aspiration, the possibility of an ovarian abscess should be considered. Complications may occur when the diagnosis is missed or if the condition is misdiagnosed to be a leiomyoma instead of an ovarian abscess. This case demonstrates the necessity of careful and adequate abdominal and pelvic examination at the time of cesarean section, especially when a pelvic abnormality is already expected.     

Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature

Ultrasound-guided transvaginal oocyte retrieval (TVOR) is a relatively simple and atraumatic method with rare complications as well as the possibility of doing it under sedation. It has become the method of choice in most IVF centres, because it results in excellent oocyte yields, with increased speed and excellent follicle and major pelvic vessel visualization, thereby decreasing the probability of vessel puncture [1]. However, the technique is not without risk such as pelvic infection, bleeding secondary a blood vessel puncture or pelvic visceral trauma. Consumption coagulopathy is a serious complication of pelvic infection and sepsis which can be life threatening if not diagnosed and corrected early, especially if surgical intervention is required. We present a case of bilateral ovarian abscesses following transvaginal oocyte retrieval showing early signs of consumption coagulopathy.     

Ultrasound in assisted reproductive technology

Transvaginal ultrasound-guided oocyte retrieval is the gold standard for in vitro fertilization (IVF) treatment. Despite its relative safety, oocyte retrieval is associated with risk to the adjacent pelvic organs, bleeding, and pelvic infection. The embryo transfer (ET) procedure is considered a crucial step in an IVF cycle. The success of the ET is dependent upon multiple factors including embryo quality, proper endometrial receptivity, and the technique by which the embryos are transferred. Optimizing the technique of ET would therefore provide the best chance for pregnancy. No standard evidence-based protocol exists, but ET with ultrasound guidance has been shown to significantly increase the chance of embryo implantation, an ongoing pregnancy, and a live birth and to improve the ease of transfer. Identifying appropriate ultrasound-guided simulation training techniques in ET would ensure adequate fellowship training without affecting the outcome of assisted reproductive technology cycles.     

Transvaginal ultrasound in the diagnosis and treatment of tubo-ovarian abscess

Transvaginal ultrasound showed tubo-ovarian abscess in 10 patients admitted for acute pelvic inflammatory disease, and transvaginal ultrasound-guided aspiration of tubo-ovarian abscess was performed under antimicrobial treatment. Only light sedation was required and the procedure was well tolerated by the patients. The short-term recovery of all patients was quick and uncomplicated. This new technique is a useful alternative for the diagnosis and treatment of tubo-ovarian abscess.     

Transvaginal ultrasound in the diagnosis and treatment of tubo-ovarian abscess

Summary. Transvaginal ultrasound showed tubo-ovarian abscess in 10 patients admitted for acute pelvic inflammatory disease, and transvaginal ultrasound-guided aspiration of tubo-ovarian abscess was performed under antimicrobial treatment. Only light sedation was required and the procedure was well tolerated by the patients. The short-term recovery of all patients was quick and uncomplicated. This new technique is a useful alternative for the diagnosis and treatment of tuboovarian abscess.     

Vertebral osteomyelitis: a rare complication of transvaginal ultrasound-guided oocyte retrieval

Objective: To present a case of vertebral osteomyelitis as a complication of transvaginal oocyte retrieval.

Design: Case report.

Setting: The IVF unit of a university-affiliated hospital.

Patient(s): A 41-year-old woman who underwent IVF-ET treatment.

Intervention(s): Standard IVF-ET treatment cycles with the use of transvaginal ultrasound for oocyte retrieval and computed tomography–guided needle aspiration.

Main Outcome Measure(s): Recovery of the patient, sequelae, and recurrence.

Result(s): Vertebral osteomyelitis was diagnosed and treated with antibiotics.

Conclusion(s): When severe low back pain occurs after ovum retrieval, vertebral osteomyelitis should be considered. Early diagnosis requires a high index of suspicion.     

Massive Vaginal Hematoma — A Complication of In Vitro Fertilization

Background

The rates of serious complications from IVF with transvaginal oocyte retrieval are low. However, as the usage of IVF continues to increase, more complications are presenting to acute care and physicians should be aware of management issues.

The use of transvaginal ultrasound to aspirate bilateral hydrosalpinges prior to in vitro fertilization: A case report

Transvaginal ultrasound has recently been introduced diagnostically for follicular monitoring, early pregnancy localization (1), pelvic structure identification, early fetal development (2), detection of ovarian enlargement in postmenopausal women (3), and detection of endometrial carcinoma (4). Transvaginal ultrasound has had a major impact on patient monitoring and treatment for in vitro fertilization and embryo transfer (IVF/ET). Therapeutically transvaginal ultrasound has been introduced for oocyte retrieval and selective pregnancy reduction. The purpose of this paper is to present the therapeutic use of transvaginal ultrasound to aspirate large bilateral hydrosalpinges which complicated embryo transfer during an in vitro fertilization cycle.     

Transvaginal, ultrasound-guided oocyte retrieval for in vitro fertilization

As compared to laparoscopic oocyte retrieval, the trans-vaginal, ultrasound-guided technique can be performed away from a formal operating room, without general anesthesia and its attendant risks and with a significant reduction in operating time. Performed under paracervical block and minimal analgesia, transvaginal, ultrasound-guided oocyte retrieval results in a fairly easily tolerated level of pain during the procedure and very minimal residual pain postoperatively. The mean number of oocytes retrieved, fertilization and embryo transfer rates, and clinical pregnancy rates are not significantly different between the two procedures. If bleeding occurs from the vaginal puncture site, it is easily controlled with pressure. In this study, postoperative pelvic infection occurred in three patients. The above advantages and associated reduction in cost achieved with the trans-vaginal, ultrasound-guided procedure make it the current method of choice for oocyte retrieval.     

Ultrasound-guided transvaginal aspiration in the management of actinomyces pelvic abscess

Background: Increasing reports of intrauterine device (IUD)-related abdominopelvic actinomycosis have been described recently. Surgical therapy has been the usual treatment when tubo-ovarian abscess is identified.Case: A 38-year-old woman suffering from Actinomyces pelvic abscess unresponsive to medical treatment underwent transvaginal ultrasound-guided needle aspiration. It resulted in marked improvement and avoided surgical treatment.Conclusion: Transvaginal needle aspiration of Actinomyces pelvic abscess may be an alternative to surgical therapy, thereby allowing the preservation of pelvic organs.     

Transvaginal ultrasound or laparoscopy for oocyte retrieval (experiences in the Ljubljana IVF program)

At present, the less invasive ultrasound-directed techniques are the methods of choice for oocyte retrieval in most in vitro fertilization and embryo transfer (FIVET) centers. Among the ultrasound-direct techniques, the transvaginal follicle aspiration guided by transvaginal ultrasound for oocyte recovery is gaining popularity in many FIVET centers. This study compare cycles outcome following transvaginal ultrasound oocyte retrieval (105 cycles) to laparoscopic oocyte retrieval (218 cycles); no statistically significant difference could be demonstrated between the groups in all parameters evaluated but better clinical results have been obtained in transvaginal ultrasound group. The Authors conclude that transvaginal oocyte recovery represents an improvement and a simplification of the FIVET procedure.     

Abdomen agudo como presentación de absceso tubo-ovárico en adolescente sexualmente inactiva

Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) rarely found in sexually inactive girls. We report the case of a 13-year-old sexually inactive adolescent who presented with abdominal pain, fever and diarrhea. The patient was diagnosed with bilateral tubo-ovarian abscess, which was resolved by laparoscopic drainage of the abscess and antibiotic therapy. Early diagnosis and treatment are essential to prevent further sequelae including infertility, ectopic pregnancy and chronic pelvic pain. TOA should be included in the broad differential diagnosis of abdominal pain with fever in adolescent girls regardless of sexual history.     

Successful in vitro fertilization-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and pelvic irradiation

OBJECTIVE: To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN: Case report. SETTING: Teaching hospital. PATIENT(S): A 29-year-old woman who had undergone Wertheim's hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S): Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S): Results of the IVF cycle. RESULT(S): A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S): This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.     

Efficacy of assisted reproductive technology during diagnostic and operative infertility laparoscopy

Women being evaluated for infertility were offered assisted reproductive technology at the time of diagnostic laparoscopy. Oocyte retrieval was performed after ovulation induction in 33 women, of whom 19 had concurrent operative laparoscopy. Gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) and embryo transfer were performed subsequently depending on laparoscopic assessment of pelvic architecture, oocyte maturity, and semen parameters. The clinical pregnancy rate was 24% per cycle and 28% per gamete or embryo transfer (four pregnancies after GIFT and four after IVF/embryo transfer). The clinical pregnancy rate per transfer did not differ significantly between the 19 women who had therapeutic operations in conjunction with laparoscopy (lysis of adhesions and/or fulguration of endometriosis) and the 13 who did not (25 versus 30%; P greater than .05). Assisted reproductive technology can be performed successfully during diagnostic infertility laparoscopy. Operative endoscopic manipulation did not adversely influence pregnancy outcome.     

Infected ectopic pregnancy presenting as unilateral tubo-ovarian abscess

Ectopic pregnancy may be a dramatic occurrence, such as in the acutely ruptured extrauterine entity, or diagnosis may be delayed in the chronic ectopic gestation. Eight cases of infected ectopic pregnancy simulating tubo-ovarian abscess are reported; the diagnosis may be difficult and misleading. Symptoms and signs include abdominal pain and vaginal bleeding following a period of amenorrhea, usually accompanied by fever. All patients in our series presented with a picture of tubo-ovarian or pelvic abscess; however, the diagnosis of infected ectopic pregnancy was made preoperatively in all due to a positive beta-hCG test. Surgery in our cases included unilateral salpingo-oophorectomy in 7, and salpingectomy in one. Attention was drawn to the fact that, in the case of unilateral tubo-ovarian abscess, infected ectopic pregnancy should be suspected whenever preoperative beta-hCG is positive.     

A new approach to follicular stimulation for in vitro fertilization: programed oocyte retrieval

Programed oocyte retrieval was performed in a group of 35 patients undergoing in vitro fertilization (IVF) treatment. The date of follicular aspiration was decided several months in advance and the cycle prior to oocyte recovery was modified with a progestagen or an estrogen-progestagen contraceptive pill. This was followed by a fixed-schedule ovulation stimulation and induction regimen. Follicular growth was not monitored. Thirty-four of the 35 patients had follicular aspiration, and at least one embryo was obtained in 30 of them. The clinical pregnancy rate (excluding cryopreserved embryos) was 20% per IVF cycle, 21% per attempted oocyte retrieval procedure, and 23% per embryo transfer cycle. Programmed oocyte retrieval is a realistic option for follicular stimulation for IVF treatment and is associated with significant practical and economic benefits.     

Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries

OBJECTIVE: To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. DESIGN: Case report. SETTING: A maternity hospital in Tel Aviv that is a major tertiary care and referral center. PATIENT(S): A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. INTERVENTION(S): Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. MAIN OUTCOME MEASURE(S): Outcome of IVF cycle. RESULT(S): A twin pregnancy in the first cycle. CONCLUSION(S): This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.     

Does intravaginal probiotic supplementation increase the pregnancy rate in IVF-embryo transfer cycles?

This study investigated the effect of intravaginal administration of probiotics immediately after oocyte retrieval on vaginal colonization and outcome of the IVF-embryo transfer cycle. One hundred and seventeen women who underwent ovarian stimulation and IVF were randomized immediately after oocyte retrieval into two groups: those who received intravaginal probiotics (study group, n = 50) and those who did not (control group, n = 67). Vaginal colonization with lactobacilli and pregnancy rate were compared between the two groups. No significant between-group differences were observed in patient age, oestrogen and progesterone concentrations on day of human chorionic gonadotrophin administration, number of oocytes retrieved, fertilization rate, number of embryos transferred, or pregnancy rate. The presence of lactobacilli in the vagina during oocyte retrieval or embryo transfer did not improve the pregnancy rate. Furthermore, intravaginal administration of lactobacilli following oocyte retrieval did not affect the prevalence of lactobacilli during embryo transfer, or the pregnancy rate. Intravaginal probiotic supplementation immediately after oocyte retrieval has no effect on vaginal colonization or pregnancy rate in IVF cycles.