Intraperitoneal bleeding following transvaginal oocyte retrieval

Objective

To investigate the risk factors for intraperitoneal bleeding following transvaginal oocyte retrieval (TVOR).

Methods

Retrospective review of records from patients who underwent TVOR between 2004 and 2008. Patients who had mild and severe intraperitoneal bleeding were compared with the same number of patients without intraperitoneal bleeding (control group) who underwent oocyte retrieval on the same day performed by the same doctor as those who experienced bleeding.

Results

Of 10251 retrieval cycles performed, 22 (0.2%) patients had intraperitoneal bleeding. Five (0.05%) patients with severe bleeding underwent laparotomy or laparoscopy, while 17 patients were managed conservatively for mild bleeding. Among patients with no bleeding, mild bleeding, or severe bleeding, there were significant differences in body mass index (P < 0.02) and number of oocytes retrieved (P < 0.01), while no differences were seen for age and pregnancy rate.

Conclusion

Patients with severe intraperitoneal bleeding had a lower body mass index, a history of surgery, were younger, and had a moderate ovarian response; those with mild bleeding were young and had a high ovarian response.     

Thrombocythemia and hemoperitoneum after transvaginal oocyte retrieval for in vitro fertilization

OBJECTIVE: To present the first report of massive hemoperitoneum in a case of essential thrombocythemia after transvaginal oocyte retrieval for IVF and review the relevant literature related to the management of patients with this condition. DESIGN: Case report. SETTING: Assisted conception unit of a tertiary care university hospital in the United Kingdom. PATIENT(S): A 37-year-old woman with essential thrombocythemia who developed massive intra-abdominal bleeding after transvaginal oocyte retrieval for IVF. INTERVENTION(S): Emergency laparotomy and right salpingoophorectomy. RESULT(S): Resuscitation of the patient. MAIN OUTCOME MEASURE(S): Overall management of the patient is discussed. CONCLUSION(S): The management of patients with essential thrombocythemia at the childbearing period poses a difficult problem. Fertility may be reduced, and an adverse outcome of pregnancy due to thrombotic or bleeding complications is a matter of concern. A multidisciplinary approach with close and early cooperation with the hematologists before initiation of IVF therapy for patients with essential thrombocythemia is essential. Efforts should be made to reduce the platelet count and assess the platelet function before embarking on IVF, keeping in mind the double jeopardy from bleeding and thrombosis in these cases.     

A case of a neurological complication after transvaginal oocyte retrieval

A patient is described who developed neurological signs of the left leg following transvaginal ultrasound-guided puncture. A hypodense lesion of the obturator space above the lumbosacral plexus was seen on ultrasound which could explain her signs, due to compression by a hematoma. She recovered completely.     

Avoidance of oocyte retrieval on the weekend through the use of scheduled ovarian hyperstimulation for in vitro fertilization and embryo transfer

Objective: To avoid oocyte retrieval for IVF-ET during the weekend, the scheduled method of ovarian hyperstimulation, in which oocyte retrieval is planned in advance for Monday through Wednesday, was evaluated.Design: A retrospective study.Setting: The IVF-ET unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital.Patient(s): One hundred seventy-eight cycles in patients undergoing ovarian hyperstimulation for IVF-ET were stimulated according to the scheduled method of ovarian hyperstimulation (scheduled group). One hundred seventy-one cycles in patients of similar age and with comparable causes of infertility were stimulated according to the conventional method of ovarian hyperstimulation for IVF-ET (conventional group).Intervention(s): In the scheduled method, under GnRH-a, the day of oocyte retrieval was determined in advance for IVF-ET. Ovarian stimulation with FSH and hMG was started 12 days before oocyte retrieval.Main Outcome Measure(s): The cancellation and clinical pregnancy rates (PRs), the days of oocyte retrieval, and other clinical parameters were evaluated in the two groups.Result(s): The cancellation rates in the scheduled and conventional groups were 9.6% and 4.7%, respectively. In about 75% of cycles in the scheduled group, oocyte retrieval was conducted on the scheduled day. When oocyte retrieval was scheduled for Monday through Wednesday, overtime work on the weekend could be avoided in 91% of the cycles without cancellation. The clinical PR was comparable between the two groups.Conclusion(s): The scheduled method of ovarian hyperstimulation for IVF-ET was useful for avoiding oocyte retrieval on the weekend.     

Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate

OBJECTIVE: To present a case of cervical ectopic pregnancy successfully treated with ultrasound-guided aspiration and single-dose methotrexate administered systemically. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old nulliparous woman with a cervical ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the cervical ectopic pregnancy followed by single-dose methotrexate administered systemically. MAIN OUTCOME MEASURE(S): Recovery of the patient, successful conservative treatment of the cervical ectopic pregnancy, with preservation of the uterus. RESULT(S): The cervical ectopic pregnancy was successfully aborted, and the reproductive capability of the patient was preserved. CONCLUSION(S): Transvaginal ultrasound-guided aspiration in combination with single-dose methotrexate administered systemically can be safely used to treat cervical ectopic pregnancies.     

A comparison of two different regimens of total intravenous anesthesia for transvaginal ultrasound-guided oocyte retrieval

ObjectiveTo evaluate the effects of Bispectral index (BIS)-guided total intravenous anesthesia (TIVA) with fentanyl-propofol vs. remifentanil-propofol on recovery time, total propofol consumption, length of postanesthesia care unit (PACU) stay, total hospital stay, postoperative pain and side effects in patients undergoing TUGOR.Study designProspective randomized observer-blinded study. The study included 60 patients that were scheduled to undergo TUGOR under BIS-guided TIVA. They were invited to enroll in the study during the period from November 2009 to August 2011 at TAIBA Hospital in Kuwait. Patients were randomly allocated into two groups of 30 patients each: general anesthesia with fentanyl and propofol (group I) or general anesthesia with remifentanil and propofol (group II). The primary outcomes of this study were recovery time and the length of PACU stay.ResultsPatients in group II had significantly rapid recovery, shorter PACU stay (23.5 ± 1.73 vs. 27.1 ± 1.43 min; P < 0.01), less amount of total propofol consumption, less total hospital stay and higher patient satisfaction with analgesia and sedation compared to patients in group I with no difference in intraoperative hemodynamic parameters, postoperative VAS scores of pain, postoperative nausea and vomiting; and without affecting IVF outcomes.ConclusionBIS-guided total intravenous anesthesia with remifentanil and propofol appears to be a safe and an effective regimen for patients undergoing TUGOR.     

A pelvic pseudoaneurysm (a rare complication of oocyte retrieval for IVF) treated by arterial embolization

This is a case report of the diagnosis and treatment of a pelvic pseudoaneurysm in a patient. Her history leads to the conclusion that this developed following egg retrieval during in vitro fertilization six years earlier.     

A randomized trial of laparoscopy and transvaginal ultrasound-directed oocyte pickup for in vitro fertilization

Ninety-four (94) couples undergoing IVF for the usual spectrum of clinical reasons and who were suitable for either laparoscopic or vaginal ovum pickup (OPU) were randomly assigned at the commencement of 166 treatment cycles to one of two OPU procedures. Both patient and clinician were informed of the allocation. If either wished to change this, then that cycle was eliminated from the trial. After a period of 15 months, 103 cycles were appropriate for analysis, of which 64 had been subject to ultrasound and 39 to laparoscopic OPU. Patients in the two groups did not differ significantly in terms of are or diagnosis, and the treatment cycles did not differ significantly in terms of stimulation used, commencing or maximum estradiol (E₂) concentrations, E₂ per follicle aspirated, or characteristics of the semen used for IVF. The rate of oocyte recovery (number of oocytes obtained per follicle aspirated), the average number of embryos available for transfer, and the pregnancy rate per oocyte recovery procedure did not differ significantly in the two groups. Ovum recovery for IVF using vaginal aspirations and ultrasound guidance is as efficacious as that which uses laparoscopy.     

Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration

Forty-four consecutive patients undergoing transvaginal follicular aspiration for in vitro fertilization underwent ultrasonic measurement of follicular diameter at the time of oocyte retrieval to determine the correlation of follicular size with recovery rates and oocyte maturity. Based on the results of 412 follicles aspirated, the data were grouped by size (11, 12–14, 15–17, 18–20, and 21 mm) and oocyte maturity. Recovery rates were significantly higher in 18- to 20-mm follicles (P<0.01) and lower in those 11 mm (P<0.001). The probability of retrieving a metaphase I or II oocyte was significantly lower in follicles 11 mm (P<0.001), somewhat higher in 12- to 14-mm follicles (P<0.01), and equally high among the other groups. There were no differences in the incidence of fractured zonas. We conclude that follicles 15 mm provide the highest probability of retrieving mature oocytes and the low recovery rates of mature oocytes from follicles 11 mm suggest that, in selected circumstances, the operating surgeon may choose not to aspirate them.     

Characterization of oocyte retrieval cycles with empty zona pellucida

Purpose

To identify the factors that characterize cycles with empty zona pellucida (EZP).

Methods

Thirty‐six oocyte retrieval cycles from which EZP were collected and another 36 cycles from which no EZP was collected were compared. The patients were divided into three groups: those with no EZP collected during any cycle, those with EZP collected during all cycles, and those experiencing cycles both with and without EZP.

Results

The mean number of oocytes collected per cycle was higher in the cycles with EZP than without EZP. The fertilization rate of the collected oocytes and the rate of good embryo formation were significantly lower in the cycles with EZP. No significant difference was observed between the three groups in terms of age, number of oocytes collected, or hormone levels before and after the oocyte retrieval. The fertilization and pregnancy rates were highest in the patients with no EZP being collected during any cycle, followed by those experiencing cycles both with and without EZP, and then by those with EZP collected during all cycles.

Conclusion

The observation of lower fertilization, poor embryo formation, and a low pregnancy rate in the patients with EZP suggests the poor quality of oocytes that were collected with EZP in the same cycle.