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

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.

Results of first in vitro fertilization cycle in women with colorectal endometriosis compared with those with tubal or male factor infertility

Hematuria and clot retention after transvaginal oocyte aspiration: a case report

Massive hematuria with hemodynamic instability—complication of oocyte retrieval

Benefit of vaginal sildenafil citrate in assisted reproduction therapy

Involvement of anticentromere antibody in interference with oocyte meiosis and embryo cleavage

P-526: An oocyte pick-up procedure complicated with pseudoaneurysm of the internal iliac artery

Comparison of metaphase II oocytes after stimulation with recombinant follicle-stimulating hormone and urinary follicle-stimulating hormone in a pituitary down-regulation regimen

Clinical outcomes for various causes of infertility with natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes

ObjectiveIt has been suggested that intravaginal deposition of seminal plasma after ovum pick up for in vitro fertilization, IVF, increases pregnancy and live birth rates. Thus, the present study aimed to detect whether intravaginal exposure to prepared seminal plasma led to an absolute increase in live birth rate after IVF by 10 % compared to placebo. DesignDouble-blind, placebo-controlled prospective study. Outcome assessment was made before the type of intervention was unblinded. The outcome data were analyzed according to an intention-to-treat protocol. SubjectsCouples scheduled for an IVF treatment cycle, in total 792 couples (393 in the seminal plasma group and 399 in the control group) were recruited over a five-year period of inclusion in a single-center setting. InterventionOn the day of ovum pick up the couples were randomized to groups receiving either vaginal deposition of prepared seminal plasma from the partner or to saline. Both participants and physician were blind to the grouping. Main Outcome MeasuresThe primary outcome was live birth. The secondary outcomes were a positive pregnancy test, defined as human chorionic gonadotropin identified in urine three weeks after ovum pick up, and clinical pregnancy, defined as an intrauterine viable pregnancy assessed by transvaginal sonography after five to seven weeks. ResultsIn the index group, 35.4 % had a positive pregnancy test (RR 0.93, 95% CI 0.78-1.10), 28.8 % had a clinical pregnancy (RR 1.00, 95% CI 0.97-1.03) and 26.5 % had a live birth (RR 0.86, 95% CI 0.70-1.07), adjusted for day of transfer, female age and number of fertilized oocytes. Corresponding rates in the control group were 37.3 %, 33.6 % and 29.8 %. No statistically significant differences regarding outcomes between the two intervention groups were found. ConclusionPrepared seminal plasma applied in the vagina directly after ovum pick-up did not increase the rates of live birth or clinical pregnancies. The importance of immunological factors to allow the implantation of an embryo is not questioned, but no improvement in the live birth rates in IVF treatment by introducing the male partner´s prepared seminal plasma after ovum pick-up could be found.

Purpose: To investigate the change pattern of leptin during in vitro fertilization and embryo transfer (IVF‐ET) treatment with controlled ovarian hyperstimulation (COH) and at the stages of very early pregnancy.Methods: The serum leptin concentration was investigated in 65 patients treated with assisted reproductive technology (ART) in five different periods (ART‐1: on the first day of ovarian stimulation with follicle‐stimulating hormone; ART‐2: at human chorionic gonadotropin administration before oocyte retrieval; ART‐3: 7 days after oocyte retrieval; ART‐4: 14 days after oocyte retrieval and ART‐5: 21 days after oocyte retrieval).Results: The leptin concentration showed significant lower values in the pregnancy group than the non‐pregnancy group at ART‐3 and ART‐4 (P < 0.05). In the pregnancy group, leptin concentration increased from ART‐1 (13.5 ± 8.2 ng/mL) to ART‐2 (23.0 ± 15.1 ng/mL) (P < 0.001). The values significantly decrease at 7 days after oocyte retrieval, from ART‐2 to ART‐3 (18.1 ± 12.0 ng/mL) (P < 0.01), and then showed no remarkable change until 21 days after oocyte retrieval. In the non‐pregnancy groups, leptin concentration increased from ART‐1 (17.3 ± 11.5 ng/mL) to ART‐2 (25.7 ± 12.1 ng/mL) (P < 0.0001). There was no remarkable change in leptin concentration until 14 days after oocyte retrieval, followed by a significant decrease in leptin concentration at ART‐4 (21.9 ± 11.9 ng/mL) to ART‐5 (18.1 ± 11.8 ng/mL) (P < 0.05).Conclusion: The serum leptin concentration increases during COH in the pregnancy and non‐pregnacy groups. In the pregnancy group, leptin concentration showed a fall of leptin values at early luteal phase. These findings might be useful to elucidate the role of leptin in the IVF‐ET patients. (Reprod Med Biol 2003; 2: 177–182)

Vitrification of immature mouse oocyte using stepwise equilibration before or after in vitro maturation

Objective To explore the indications of conservative treatment and to explore the laparotomy for children with abdominal trauma, so as to improve the diagnosis and treatment of abdominal injury in children. Methods This retrospective review included 89 children who had an abdominal trauma which was classified according to the injury situation. Results (1)Of 25 patients with hepatic injury, 1 underwent surgery.Among the 48 patients with splenic injury, 46 cases were treated successfully by conservative treatment, only 1 underwent splenectomy and another adopted splenic neoplasty.Fourteen patients suffered from gastrointestinal injury, and 4 of them underwent emergency laparotomy, however a delayed perforation of digestive tract occurred in 1 child when he was in hospital 4 days later.Eight cases of pancreatic trauma were treated successfully by conservative treatment, the same as 6 cases of renal and adrenal contusion.One child with uterus and bladder injury was atopted emergency surgical treatment.(2) Unlike adults, conservative management of hepatic and splenic injuries was successfully applied to the vast majority of children.Operative treatment ought to be carried out when hemodynamic stability could not be maintained despite a continuous intravenous fluids and blood transfusion, or when the total amount of blood transfusion exceeds 40 ml/kg.(3)CT was very useful for children with gastrointestinal injury, especially for one cannot stand for abdominal X-ray examination.Operative treatment ought to be carried out timely in those with pneumoperitoneum or abdominal distension.We should pay particular attention to the possibility of delayed perforation.(4)In general, pancreatic injury could be treated conservatively except the ones with pancreatic rupture.(5)Children with bladder and uterine injury often suffered from severe trauma, and needed to be operated timely. Conclusion Children with abdominal injury should be highly valued in primary hospital.Internal bleeding caused by substantial organ injury is the leading cause of death in children, and the delayed diagnosis and treatment of the injured cavity organs is another important cause of the death.Therefore, early accurate diagnosis, active treatment, comprehensive treatment of severe combined injuries and complications are the key to successful treatment of such patients. Key words: Children; Abdominal blunt injuries; Diagnosis,

The availability of normal embryos for transfer is difficult to predict in PGD cycles.

Objective To investigate the reproduction strategy choice of endometriosis (EMS) patients with infertility, the risk of ovarian EMS cyst treated conservatively, the risk and prevention of ovarian EMS cyst concurrent with pelvic abscess after oocyte retrieval. Methods A case about ovarian endometriosis cyst concurrent with pelvic abscess and intestinal obstruction after oocyte retrieval was analyzed and the literatures were reviewed. Results The EMS infertile patient complicated with pelvic abscess, basin celiac adhesion and part of intestinal obstruction after oocyte retrieval failed in conservative treatment and was finally cured with surgery. Conclusion To select the best assisted reproduction strategy of EMS infertility, many factors should be considered comprehensively such as age, ovarian function, disease severity, and male factors. To prevent infection after oocyte retrieval, preoperative vaginal preparation could conduct more thorough before transvaginal oocyte retrieval, intraoperative standardized operation is contributed to avoid puncturing vaginal wall repetitively, at the same time avoid piercing chocolate cyst and use broad-spectrum antibiotics to prevent infection postoperatively. For patients with pelvic infection, frozen embryo and selective transfer are considered. Key words: Ovarian endometriosis cyst; Pelvic abscess; Intestinal obstruction; Oocyte retrieval; In vitro fertilization-embryo transfer (IVF-ET)