BLEEDING, SEVERE PELVIC INFECTION, AND ECTOPIC PREGNANCY

Transvaginal ultrasound-guided aspiration of oocytes is a well-accepted and universally used method in assisted reproduction [1, 2]. Its major advantages include easy access to ovarian follicles with excellent oocyte yield and good visualization of the major pelvic vessels. It is done as a day care procedure, either under intravenous analgesia and sedation or under general anaesthesia, and is usually atraumatic. Nevertheless, there are some inherent risks, namely puncture of blood vessels and hemoperitoneum, bleeding from the vaginal vault puncture site, rupture of adnexal cystic masses, bladder injury, bowel perforation, trauma to pelvic organs, and pelvic infection. In addition, embryo transfer (ET) itself may be associated with complications such as pelvic infection, multiple pregnancy (which is directly related to the number of transferred embryos), spontaneous abortion, and extrauterine pregnancy (EUP). Maxwell et al. [3] have reported on the incidence of both serious and minor complications in young women undergoing 886 oocyte retrievals for oocyte donation. While the rate of serious complications, which included ovarian hyperstimulation syndrome, ovarian torsion, infection, and ruptured ovarian cyst, was 0.7%, the rate of minor complications severe enough to prompt the donor to seek medical attention after retrieval was 8.5%. A study by Levi-Setti et al. [4] has assessed the incidence of complications necessitating hospitalization or outpatient management following transvaginal oocyte retrieval in a large assisted reproductive technology (ART) programme. The most important, identifiable, risk factors for the occurrence of complications were high number of oocytes retrieved, a long duration of the procedure and mean time per oocyte retrieved, inexperience of the surgeon, younger patients with a lesser BMI, and history of prior abdominal or pelvic surgery or pelvic inflammatory disease (PID).