Can Doppler ultrasound-guided oocyte retrieval improve IVF safety?

Abstract

Transvaginal ultrasound-guided oocyte retrieval has gained universal acceptance with an excellent safety record overall. However, even with contemporary ultrasound resolution, the aspiration needle can injure adjacent pelvic organs and blood vessels and result in external and internal bleeding. Although the idea that Doppler ultrasound might reduce the risk of blood vessel injury during follicular aspiration seems to be plausable, measurement of peritoneal blood loss and the validity of this opinion has never been appropriately tested. Using a proposed classification method in an IVF programme, it was estimated that a significant peritoneal bleeding occurred in 56/898 (6%) of IVF patients. Although Doppler ultrasound was routinely used in all patients, it did not predict 24/53 (45%) of the patients with moderate peritoneal bleeding. In 8/53 cases (15%) with moderate peritoneal bleeding, vaginal bleeding was also detected and correctly predicted during oocyte aspiration using colour Doppler vaginal vessel imaging. Colour Doppler ultrasound guidance is an easily accessible technology with a theoretical promise to improve IVF safety and, with proper usage, has the potential to reduce haemorrhagic complications.

Ultrasound in assisted reproduction: a call to fill the endometrial gap

“…The use of Doppler color imaging can theoretically reduce accidental vascular trauma during follicular aspiration, but its added value has not been validated. When studied, the use of Doppler could not predict peritoneal bleeding as measured in ultrasound evaluation after follicular puncture (52). Therefore, to date there are insufficient data to support its routine use.…”

Minimizing the Risk of Infection and Bleeding at Trans-Vaginal Ultrasound-Guided Ovum Pick-up: Results of a Prospective Web-Based World-Wide Survey

“…The use of color Doppler may detect small blood vessels in the vaginal walls and inside the ovary and may thus reduce the risk of hemorrhage at TV-OPU [15]. Though Serour et al [16] recommend the routine use of color Doppler at TV-OPU, Risquez and Confino [17] advice that the identification of smaller blood vessels on ultrasound Doppler may not entirely remove the risk of moderate to severe bleeding. Shalev et al [15] recommend the use of a pelvic ultrasound scan before discharging the women from the unit to Iatrogenic pelvic infection following TV-OPU can occur as a result of ascending infection (follicular aspiration needle carrying micro-organisms from the vagina into the pelvis), by the reactivation of a dormant infection (from a previous PID) or very unlikely, from fecal peritonitis secondary to bowel injury [6].…”

Recommendations for good practice in ultrasound: oocyte pick up†

“…It is relevant to first have a panoramic view of the ovary and then have a closer look. A larger view field is preferable during the OPU—magnify until the whole ovary occupies 75% of the field (depending on the dynamics of the ovary)—to ensure visualization of the intrapelvic part of the needle during the OPU.In case of doubt, Doppler study is advised for recognition of the vascular structures [positioned in the line between transducer (vaginal wall) and ovary] and to reduce the risk of haemorrhagic complications (Risquez and Confino, 2010). Using Doppler imaging during the OPU procedure may be seen as an additional complex study to perform, switching from bi-dimensional to Doppler image, and it is not recommended to do this during the OPU.…”