To investigate the incidence of serious and minor complications experienced by women undergoing controlled ovarian hyperstimulation and oocyte retrieval for oocyte donation. Retrospective study. University-based IVF center. Five hundred eighty-seven donors underwent 973 cycles of controlled ovarian hyperstimulation and 886 oocyte retrievals for anonymous or directed oocyte donation. Controlled ovarian hyperstimulation; oocyte retrieval. Complications of the procedure. The rate of serious complications, which included ovarian hyperstimulation syndrome, ovarian torsion, infection, and ruptured ovarian cyst, was 6 in 886 (0.7%) retrieval cycles. The rate of minor complications severe enough to prompt the donor to seek medical attention after retrieval was 8.5%. The cancellation rate after stimulation cycle initiation was approximately 9%, regardless of whether the donation was anonymous or directed. This study provides information on the incidence of serious complications experienced by oocyte donors after controlled ovarian hyperstimulation and oocyte retrieval. It provides evidence that with careful monitoring, and when a liberal cancellation policy is followed, oocyte donors experience lower rates of ovarian hyperstimulation syndrome, compared with infertile women undergoing IVF. Furthermore, the study provides the first set of data on the rate of symptomatic minor complications experienced by oocyte donors. This information will help clinicians administer appropriate informed consent to the young women who present themselves as potential oocyte donors.
Levi-Setti PE et al., 2018·Fertility and Sterility·
Open Access
To assess complications encountered after transvaginal oocyte retrieval procedures. Retrospective analysis. University hospital, fertility center. PATIENT(S): A total of 23,827 consecutive transvaginal oocyte retrieval procedures in 12,615 patients. INTERVENTION(S): Oocyte retrieval procedures performed between June 1996 and October 2016. MAIN OUTCOME MEASURE(S): All oocyte retrieval complications. Those requiring hospital admission for at least 24 hours were considered severe. RESULT(S): A total of 96 patients (0.76 %) suffered complications, with hospital admission necessary for 71 patients (0.56 %). When calculated per retrieval, the overall complication rate was 0.4%, whereas 0.29% was the admission rate, with an average duration of hospital stay of 2.77 ± 2.5 days. A surgical procedure was necessary for 24 patients (0.1% per retrieval and 0.19% per patient). Multivariate analysis showed a significant correlation between complications and women age, body mass index (BMI), the number oocyte retrieved, and the mean time to complete oocyte retrieval. The incidence of complications was significantly higher for physicians who had performed <250 retrievals compared with those who had completed >250 retrievals (odds ratio 0.63, 95% confidence interval 0.40-0.99). CONCLUSION(S): Oocyte retrieval can be considered a safe procedure but is not without risks. The most important, identifiable, risk factors for the occurrence of complications are: [1] high number of oocytes retrieved, [2] a long duration of the procedure and mean time per oocyte retrieved, [3] inexperience of the surgeon, [4] younger patients with a lesser BMI, and [5] history of prior abdominal or pelvic surgery or pelvic inflammatory disease. CLINICAL NCT03282279.
We report the complications observed after transvaginal oocyte retrieval guided by ultrasound in 7,098 IVF cycles. The frequency of severe complications in our patients was 0.08%, of which four cases were intraperitoneal bleeding (0.06%) and two were cases of ovarian abscess (0.003%).
To test consumables and other products used during oocyte collection, sperm preparation, IUI, embryo culture, and IVF-embryo transfer for their possible reprotoxic properties. A prospective 4-year survey of reprotoxicity testing of consumables and other products used in assisted reproductive technologies (ART). Private infertility center in a university-affiliated teaching hospital. INTERVENTION(S): Thirty-six products of 72 different brands, including plastics, syringes, tubing, and surgical gloves were analyzed for their reprotoxicity in 350 human sperm survival tests (SpST). MAIN OUTCOME MEASURE(S): The SpST index: percentage progressive motility of test sample/percentage progressive motility of control sample after 24 and 96 hours. RESULT(S): Thirteen of 36 products were found to be reprotoxic: an SpST index <0.85 was noted 24 and 96 hours after exposure. These products included eight brands of unpowdered surgical gloves, two types of hysterometers and one type of tubing attached to the oocyte collection needle, one type of ovum pickup procedure needle, and one type of embryo transfer catheter. One type of condom used for ultrasound, one type of sterile Pasteur pipette and petri dish, as well as the cover of a specimen container, were reprotoxic. CONCLUSION(S): The SpST is an inexpensive, easy, and reliable method to identify potential reprotoxic products and consumables used in ART procedures. These data underline the importance of the inclusion of the SpST in a continuous quality control (QC) program of ART outcome.
Transvaginal ultrasonic follicle puncture has now become the method of choice for oocyte retrieval among most in vitro fertilization (IVF) units. The procedure, which involves puncture then aspiration of ovarian follicles, inevitably results in damage to the fine vascular network of blood vessels on the ovarian surface and theca interna layer, and tends to produce varying degrees of blood loss. The transvaginal ultrasonically guided retrieval of oocytes can be considered noncomplicated when the procedure does not result in injury to iliac vessels, trauma to pelvic viscera, or iatrogenic pelvic infections (1, 2), which would necessitate laparoscopy and or laparotomy. The aim of our study was to quantify the amount of blood loss that should be considered “normal” after noncomplicated transvaginal ultrasonically guided retrieval of oocytes, to characterize the factors that are related to the amount of blood loss, and to identify the patients who have the highest risk of hemorrhage.
Before beginning our study, we performed a power analysis of potential participants. We established the sample size after evaluating the number of women of fertile age in our area, and we used the previous years’ data to calculate the prevalence of sterility problems and the percentage of women who had undergone in vitro fertilization. Thus, our prospective study was based on a sample of 220 women, 25 to 42 years old, who underwent assisted reproduction from January 1998 to May 1999. We excluded the women who had mild or severe ovarian hyperstimulation syndrome or thrombocytopenia, those who were taking anticoagulant drugs, and those who were overweight (body mass index 25 to 30) or obese (body mass index greater than 30). The study was approved by the local hospital ethics committee and all of the participants gave written informed consent.