Does the presence of endometriosis cause a challenge for transvaginal oocyte retrieval? A comparison between patients with and without endometriosis

Abstract

Objective:The aim of the study was to compare patients with and without endometriosis regarding performance rates, difficulties, and complications associated with transvaginal oocyte retrieval (TVOR) procedures.Material and Methods:A prospective cohort study was conducted at the In Vitro Fertilization Unit of the Division of Reproductive Endocrinology and Infertility Department of a university hospital. Fifty-eight patients with endometriosis and 61 patients without endometriosis underwent TVOR procedures consecutively. Primary outcome measures were; number of needle entries per patient and performance rating defined as the total number of oocytes retrieved per vaginal needle entry. The requirement for manual compression of the abdominal wall (assistance) to reach the ovaries, procedure-related pain, and procedural complications were also evaluated.Results:The median number of needle entries through the vaginal wall per patient was comparable between the two groups (p=0.45). Performance rates were higher in the control group (p=0.001). Performance rates and total number of the needle entries through the vaginal wall were not significantly correlated with ovarian endometrioma (OMA) diameter (r=0.28; p=0.68; r=0.275, p=0.068, respectively) in the endometriosis group. Body mass index (BMI) scores were found to be correlated with the number of the needle entries and higher BMI scores were associated with higher numbers of vaginal wall punctures (p<0.001). The requirement for manual compression of the abdominal wall was significantly higher in the control group (57.4% vs 27.6%, p=0.001). A similar proportion of women needed analgesic medications after the TVOR procedure in both groups (10.3% vs 16.4%, p=0.33). Hospital readmissions for any symptoms were also comparable between the two groups (p=0.22). Three women were treated for pelvic infection, all of whom were in the endometriosis group.Conclusion:Endometriosis seems to cause a challenge for TVOR that may have reflection on individual surgeon’s performance rates for the procedure, independently from the diameter of a pre-existing OMA or ovarian adhesions. Obesity is another factor that may present a challenge for the procedure.

Effect of body mass index on the efficacy of paracervical block for ultrasound-guided transvaginal oocyte retrieval as assessed by requirement of rescue propofol

“…The access to the ovary is difficult in these patients, and multiple punctures are required. [14] This might explain the failure of PCB to provide adequate analgesia. Lignocaine gets concentrated in follicular fluid, especially in those that are aspirated later on.…”

Recommendations for good practice in ultrasound: oocyte pick up†

“…The benefit of aspiration on the day of OPU needs further study (Hammadieh et al., 2008; Fouda et al., 2015; Zhou et al., 2016). Patients with potential infectious risk (HIV, hepatitis) should be managed in an isolated circuit or in specialized centres to avoid cross-contamination.In women with endometriosis, OPU can be challenging and it may affect the individual operator’s or centre’s performance rate (Kasapoglu et al., 2018). Endometriomas should not be aspirated.…”

“…Dermoid cysts should not be punctured during OPU, since this could increase the risk of PID and peritonitis. In patients with an endometrioma or teratoma, the risk of PID is increased, even if they have not been punctured (Moini et al., 2005; Benaglia et al., 2008; Villette et al., 2016; Kasapoglu et al., 2018). These patients should be counselled preoperatively and consent obtained appropriately.If an endometrioma or a haemorrhagic follicle is inadvertently punctured, the needle should be immediately withdrawn and flushed with media, and the collecting tube should be changed.In patients with borderline ovarian tumours, it is unclear whether ART procedures are associated with an increased risk of recurrence (Denschlag et al., 2010).…”

“…In women with endometriosis, OPU can be challenging and it may affect the individual operator’s or centre’s performance rate (Kasapoglu et al., 2018). Endometriomas should not be aspirated.…”

“…Dermoid cysts should not be punctured during OPU, since this could increase the risk of PID and peritonitis. In patients with an endometrioma or teratoma, the risk of PID is increased, even if they have not been punctured (Moini et al., 2005; Benaglia et al., 2008; Villette et al., 2016; Kasapoglu et al., 2018). These patients should be counselled preoperatively and consent obtained appropriately.…”