Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Abstract

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively.

Severe Hemoperitoneum due to Ovarian Bleeding after Transvaginal Oocyte Retrieval with Surgical Management: A Retrospective Analysis and Comprehensive Review of the Literature

“…No duplication of the studies or use of the same population of patients was found. After screening the titles and abstracts of publications, hemoperitoneum cases due to adjacent vessel lesions (n = 3) were excluded [ 15 , 16 , 17 ], as well as those from urinary tract lesions (n = 6) [ 10 , 31 , 32 , 33 , 34 , 35 ]. Out of all full-text articles assessed for eligibility, 26 publications and 7 reports were excluded due to unknown bleeding sources causing hemoperitoneum or unclear presentation of patient data [ 5 , 6 , 26 , 36 , 37 , 38 , 39 ].…”

“…We focused on hemoperitoneum as a result of ovarian bleeding with surgery performed for hemostasis, and not from bleeding from other sources, such as injury of blood vessels [ 15 , 16 , 17 , 39 ] or from bladder and ureteral injuries [ 10 , 31 , 32 , 33 , 34 , 35 ].…”

“…Since “sonographically controlled vaginal culdocentesis” was first described by Gleicher et al in 1983, the technique of ultrasound-guided transvaginal oocyte retrieval (TVOR) has become the method of choice in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) for oocyte collection, and about 99% of TVOR interventions are performed this way [ 1 , 2 , 3 ]. However, introducing a sharp needle through the vaginal wall and into the ovary under ultrasound guidance and monitoring can cause damage to the vagina, parametric tissues [ 4 , 5 , 6 ], and ovary-adjacent pelvic organs, such as the uterus, bladder, urethra [ 7 , 8 , 9 , 10 ], bowels [ 11 , 12 , 13 ], and large pelvic blood vessels [ 14 , 15 , 16 , 17 ].…”