Ultrasound-guided Oocyte Retrieval Research Articles

Transvajinal ultrason eşliğinde oosit toplama işleminde anestezi yönetimi: Mini derleme

Oosit toplama işlemlerinde anestezi/analjezi yönetimi, in vitro fertilizasyon tedavisinde hasta konforunun, güvenliğinin ve prosedürel başarının sağlanmasında çok önemli bir rol oynamaktadır. Bu mini derleme, transvajinal ultrason eşliğinde oosit toplanması planlanan hastalarda bilinçli sedasyon, rejyonal anestezi veya genel anestezi yoluyla bireysel hasta ihtiyaçlarına göre yeterli analjezi ve konfor sağlamak için işlem öncesi/işlem sırasındaki hususları, anestezi tekniklerinin ve anestezik ilaçların seçimini ele almaktadır. Klinisyenler anestezi tekniklerini seçerken hastanın komorbiditelerini, ilaç kullanımlarını ve prosedürel gereklilikleri göz önünde bulundurmalıdır.

A Comparison of Oocyte Yield between Ultrasound-Guided and Laparoscopic Oocyte Retrieval in Rhesus Macaques.

Obtaining quality oocytes is a prerequisite for ART-based studies. Here we describe a method for transabdominal ultrasound-guided (US) oocyte retrieval in rhesus macaques (Macaca mullata) and compare it to the standard surgical approach using laparoscopy (LAP). We analyzed oocyte yield from six continuous reproductive seasons (2017-2023) that included n = 177 US-guided and n = 136 laparoscopic oocyte retrievals. While the ultrasound-guided technique retrieved significantly fewer oocytes on average (LAP: 40 ± 2 vs. US: 27 ± 1), there was no difference in the number of mature metaphase II oocytes (MII) between the two techniques (LAP: 17 ± 1 vs. US: 15 ± 1). We show that oocytes retrieved by the ultrasound-guided approach fertilize at the same rates as those obtained via the laparoscopic procedure (LAP Fert Rate: 84% ± 2% vs. US Fert Rate: 83% ± 2%). In conclusion, minimally invasive ultrasound-guided oocyte retrieval improves animal welfare while delivering equivalent numbers of mature oocytes, which are ideal for ART. Furthermore, we show that oocyte competency, as represented by fertilization rate, is not affected by retrieval technique. Therefore, the Oregon National Primate Research Center (ONPRC) has adopted the ultrasound-guided approach as the standard technique for oocyte retrieval.

Laparoscopic oocyte retrieval for fertility preservation in a patient with squamous cell carcinoma of the vagina

To describe a feasible fertility preservation strategy in a woman with vaginal carcinoma. Video case report demonstrating the diagnostic work-up and laparoscopic oocyte retrieval performed under regional anesthesia. University tertiary care hospital. A 35-year-old nullipara woman presenting with vaginal bleeding and foul-smelling vaginal discharge. After a comprehensive diagnostic work-up, a final diagnosis of squamous cell carcinoma of the vagina stage II (FIGO classification) was made. As per the patient's desire, before undergoing chemo-radiotherapy, the patient underwent oocyte cryopreservation. Transvaginal retrieval of oocytes was not feasible due to stenosis of the vaginal introitus and the potential risk of intracavitary tumor cell spillage. Transabdominal ultrasound-guided oocyte retrieval was not possible due to the body habitus. The patient underwent ovarian stimulation for in vitro fertilization. In order to minimize estrogen levels, letrozole was used during the controlled ovarian stimulation (COS). Laparoscopic oocyte retrieval was performed under spinal anesthesia. Successful laparoscopic egg retrieval and cryopreservation in a woman with squamous cell carcinoma of the vagina. A total follicular count of 9 was estimated before the oocyte retrieval. Eight oocytes were retrieved at laparoscopy, and eight mature oocytes were successfully cryopreserved. No complications were encountered, and the patient was discharged on the same day of surgery. To the best of our knowledge, this is the first published case of fertility preservation using the laparoscopic approach in a patient with vaginal cancer. Letrozole is a valuable strategy to reduce high estrogen in patients with gynecological cancer undergoing COS. Laparoscopy oocyte retrieval, performed under regional anesthesia, can be performed in an ambulatory setting and should be considered an effective fertility preservation strategy in patients with large vaginal tumors.

Self-made transvaginal ultrasound simulator: new training equipment in ultrasound evaluation of controlled ovarian stimulation and oocyte retrieval.

We sought to create and describe a self-made simulator designed and created for teaching purposes: a high-fidelity ultrasound phantom for demonstrating antral follicle count, ultrasound supervision of controlled of ovarian stimulation, and ultrasound-guided oocyte retrieval. The uterus and ovaries of the ultrasound phantom were made from beef tongue, a male condom, latex gloves, cotton suture threads, bi-distilled water, and ultrasound gel. The components were placed in a pelvis created using three-dimensional (3D) printing. The phantom was presented to and evaluated by a group of 14 physicians pursuing a postgraduate course in reproductive medicine. Two training stations were structured: one to simulate antral follicle count and controlled ovarian stimulation and the other to simulate ultrasound-guided oocyte retrieval. Future specialists were requested to complete a feedback questionnaire evaluating the self-made simulator and the two practice stations. The transvaginal ultrasound phantom was successfully created, making it possible to simulate antral follicle count, ultrasound control of ovarian hyperstimulation, and oocyte retrieval, and to capture ultrasound images. A review of the answers provided in the feedback questionnaire showed that the phantom had a good appearance and design, was realistic, helped to improve motor coordination, and could be a useful tool in the training of specialists in assisted reproduction. This phantom was designed to enable instruction and practice in the evaluation of ovarian follicles and ultrasound-guided oocyte retrieval in a supervised training environment. This self-made simulator is proposed as a training tool that could be included in the curricular structure of residency and postgraduate programs in reproductive medicine.

Female with peritonitis and abdominal distention.

A G0 35-year-old female with a body mass index (BMI) of 21 and history of antibiotic allergies presented to the emergency department with diffuse abdominal pain. Two days prior, she had a transvaginal ultrasound-guided oocyte retrieval for mature oocyte cryopreservation and 36 hours before the procedure received a human chorionic gonadotropin (hCG) “trigger shot.” She was tachycardic, but otherwise hemodynamically stable. On abdominal examination, she had a distended abdomen with diffuse tenderness to percussion and rebound tenderness. A point-of-care ultrasound demonstrated free fluid and a computed tomography (CT) of the abdomen/pelvis with intravenous contrast was obtained after consultation with surgery and obstetrics (Figures 1-3). CT revealed bilateral enlarged ovaries with follicles, the largest at 17 × 15 × 10 cm, with ascites and bilateral pleural effusions. No free air or active hemorrhage was identified. She underwent paracentesis of 2.5 L with administration of albumin and anticoagulation. Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of assisted reproduction technology, described as cystic enlargement of the ovaries and fluid shifts from the intravascular space to the third space.1, 2 It can occur in 1%–5% of cycles with risk factors of low BMI, polycystic ovarian syndrome, allergy history, high doses of hCG, and large number of follicles.2, 3 Peritonitis can occur because of the release of inflammatory mediators or rupture of follicular cysts.3 Severe OHSS is characterized by ascites, pleural effusions, and hemoconcentration. In addition to OHSS, complications of oocyte retrieval, albeit rare, must also be considered as intraperitoneal hemorrhage, bowel perforation, or infection.4

Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach.

We aimed to compare the feasibility, effectiveness, and safety of transabdominal ultrasound-guided oocyte retrieval (TUGOR) using a vaginal probe and traditional vaginal approach in virgin patients undergoing oocyte cryopreservation. A total of 116 virgin patients who underwent transabdominal ultrasound-guided oocyte retrieval using a vaginal ultrasound probe and 33 patients matched for BMI, antral follicle count, age, day 3 FSH, estradiol, and AMH who underwent vaginal approach were enrolled. Mean number of total oocytes collected, mean number of cryopreserved MII oocytes, duration of the procedure, duration of stimulation, mean gonadotropin consumption, mature oocyte ratio, and a modified follicle-oocyte index were compared between the groups. No statistical difference was found between the groups in mean number of follicles > 12mm (4.62 ± 4.54 vs. 5.44 ± 4.52), mean number of oocytes collected (4.44 ± 4.14 vs. 5.33 ± 4.52), mean number of cryopreserved MII oocytes (4.01 ± 3.67 vs. 4.53 ± 4.13), mean duration of the procedure (12.4 ± 1.2 vs. 13.4 ± 1.6min), mean days of stimulation (8.05 ± 1.91 vs. 8.35 ± 1.72days), mean gonadotropin consumption (1507.9 ± 475.3 vs. 1571.74 ± 404.6 units), mature oocyte ratio (0.78 ± 0.24 vs. 0.82 ± 0.26), and modified follicle oocyte index (0.86 ± 0.63 vs. 0.84 ± 0.19). In the TUGOR group, superficial epigastric artery injury occurred in two patients and resolved spontaneously. Transabdominal oocyte retrieval using a vaginal ultrasound is a safe, effective, and feasible method of oocyte retrieval in some selected patient groups.

Transvaginal ultrasound-guided oocyte retrieval in cattle: State-of-the-art and its impact on the in vitro fertilization embryo production outcome.

Transvaginal ultrasound-guided oocyte retrieval (commonly called OPU) and in vitro embryo production (IVP) in cattle has shown significant progress in recent years, in part, as a result of a better understanding of the full potential of these tools by end users. The combination of OPU and IVP (OPU-IVP) has been successfully and widely commercially used worldwide. The main advantages are a greater number of embryos and pregnancies per unit of time, faster genetic progress due to donor quick turn around and more elite sires mating combinations, larger spectrum of female age (calves, prepuberal, heifer, cow) and condition (open, pregnant) from which to retrieve oocytes, a reduced number of sperm (even sexed) required to fertilize the oocytes, among other benefits. OPU-IVP requires significant less donor preparation in comparison to conventional embryo transfer (<50% of usual FSH injections needed) to the extent of no stimulating hormones (FSH) are necessary. Donor synchronization, stimulation, OPU technique, oocyte competence, embryo performance, and its impact on cryopreservation and pregnancy are discussed.

Fibroids and Infertility: Transabdominal Ultrasound Guided Oocyte Retrieval in Patient with Massive Multiple Leiomyomas - Case Report

The World Health Organization (WHO) defines infertility as a disease characterized by the absence of pregnancy after 12 or more months of regular unprotected sex. Couple infertility is an increasingly present problem in today’s society. We present a case of a patient with assisted reproduction program complicated with uterus altered by numerous fibroids who obstructed routine transvaginal oocyte retrival. Routine transvaginal procedure of oocyte retrival was impossible due to the size and shape of the uterus altered by numerous fibroids. The aspiration was done by transabdominal ultrasound-guided follicular aspiration. A successful embryo transfer was performed without complications. Patient was successfully delivered at 32 weeks of gestation. Main objective of this case report is to bring to the light the challenging situations that infertility specialist face, and alternative solutions that deviate from the daily routine but bring the final desired result – birth of the healthy newborn.

P–794 Prevalence of positivity for SARS-CoV–2 RNA in follicular fluid in infertile patients

Abstract Study question Is Sars-Cov–2 present in the follicular fluid of infertile patients? Summary answer In the experience of the Infertility and IVF Unit, University Of Bologna, Italy, RNA of SARS-Cov–2 was not detected in the follicular fluid. What is known already Data on the risk of virus presence in reproductive cells and transmissibility in IVF procedures are very limited. In literature only one study reports the detection of SARS-Cov–2 viral RNA in oocytes of PCR positive women. Research of RNA in follicular fluid could be a marker able to indicate whether to continue IVF treatments in the case of swab-positive patients. Study design, size, duration Prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from March 2020 to January 2021. 451 IVF cycles were performed on 902 patients. In addition 59 cycles of oocyte cryopreservation were also performed to fertility preservation in oncological patients. In all positive swab patients was analyzed the follicular fluid for RNA virus detection. Participants/materials, setting, methods 961 patients underwent telephone triage before going to the IVF Center to identify subjects with suspected or confirmed infection. Body temperature was measured on all patients before entering the IVF Center. All patients were subjected to real-time analysis (RT PCR) of pharyngeal swab samples 48 hours before transvaginal ultrasound-guided oocyte retrieval. In case of positive swab, PCR was performed on follicular fluid. Main results and the role of chance In our population of infertile patients the incidence of SARS COV–2 infection positivity was 0.4% (4/961). No IVF treatments were suspended. The oocytes of the 4 women with positive swab were cryopreserved using closed devices stored in a special dedicated cryogenic container. No viral RNA was detected in the follicular fluid. Limitations, reasons for caution there are no limitations to the study. Wider implications of the findings: The absence of SARS-COV–2 RNA in the follicular fluid is a reassuring result in the storage and future use of oocytes. Trial registration number Not applicable

Lars Hamberger: in memory of a Nordic pioneer in IVF.

Professor Emeritus Lars Hamberger, former Chief Editor of Acta Obstetricia et Gynecologica Scandinavica (AOGS), passed away at the age of 82 years on 2 June 2021. Lars Hamberger was an internationally renowned scientist in the field of assisted reproductive technology (ART) and was the initiator and team leader behind the first in vitro fertilization (IVF) baby within the Nordic countries. The birth, in 1982 at Sahlgrenska University Hospital in Gothenburg, occurred only 4 years after the world’s first IVF baby was born. This accomplishment cemented Sweden’s reputation within the international IVF scene as the 5th country in the world to successfully develop the revolutionary technique. Lars Hamberger continued his scientific and clinical work in ART throughout his career, inspiring many young colleagues in Sweden and around the world to pursue careers within this rapidly evolving field. Lars Hamberger studied medicine at the University of Gothenburg and worked at Sahlgrenska University Hospital for most of his career. His doctorate training was in reproductive physiology, specifically ovarian metabolism. His innovative mind led to the development of a micro-diver technique to measure the oxygen consumption of ovarian cells. He became Associate Professor in Physiology in 1968, some months after receiving his PhD. After completing residency training at Sahlgrenska, Hamberger became an Associate Professor in Obstetrics & Gynecology in 1974. He was active in conducting research on ovarian physiology and closely followed the international work carried out to develop a technique that would fertilize the human oocyte outside the body. The successful creation of this IVF technique was largely due to the scientific efforts of Robert Edwards in Cambridge. In 1978, the Cambridge group reported the birth of Louise Brown. Soon after, Hamberger formed a team of clinicians and scientists to set up IVF in close contact with the Cambridge team, proving successful in 1982 with their first live birth at Sahlgrenska. In 2010, Robert Edwards was awarded the Nobel prize in physiology/medicine for the scientific development of IVF. Lars Hamberger was appointed Professor of Obstetrics & Gynecology at Karolinska Institute in 1983 but returned to the University of Gothenburg the following year as a professor. IVF was soon established as a clinical treatment at Sahlgrenska and Hamberger created a large adjoining research laboratory, “Spec-lab”, for translational research in ART. This center attracted scientists from all over the world to work in developing IVF and ART even further. One major IVF invention from the Sahlgrenska center was the forming of transvaginal ultrasound-guided oocyte retrieval in 1987. With this technique it was possible to avoid laparoscopy surgery when obtaining oocytes. Another major invention in ART was intracytoplasmic sperm injection (ICSI), developed by the Brussels group in 1992. Lars Hamberger and his team quickly learned the technique and Sahlgrenska became the second center in the world with a live birth after ICSI. Several major research findings in ART came from the Sahlgrenska center, including the establishment of elective single embryo transfer as a routine, long-term follow-up of IVF children, and uterus transplantation. Alongside all the science in the laboratory, Hamberger also made space for the world-renowned photographer Lennart Nilsson, who created the book “A Child is Born”, with Lars Hamberger as co-author. The book has been translated into 18 languages. Lars Hamberger was not only a scientist and clinician but also an entrepreneur within the business field. He was co-founder of the second private IVF clinic in Sweden, the stem-cell company Cellartis, as well as Vitro Life, now a major global company within the area of Culture media and products for assisted reproduction. Lars Hamberger supervised several PhD students within the Departments of Physiology and Obstetrics & Gynecology and hosted a great number of international visiting scientists. The famous Spec-lab became an international hub for advanced research in ART, greatly aided by Hamberger’s scientific generosity and hospitality. Lars Hamberger became honorary member of the European Society of Human Reproduction (ESHRE) in 2011 and was the Chief Editor of AOGS from 1999 to 2000. On a personal level, Lars had many interests but was particularly passionate about the arts. Lars himself was a talented painter and as a young man dreamed of a future as a painter, despite the disapproval of his father, Professor Carl-Axel Hamberger. However, Hamberger pursued his painting in parallel with his scientific career and had several art exhibitions after retirement. Lars Hamberger will be remembered with warmth and gratitude for being instrumental in the establishment of ART in the Nordic countries and being essential to the development of AOGS.

Experience with transplantation of human cryopreserved ovarian tissue to a sub-peritoneal abdominal site.

Is a sub-peritoneal abdominal site a suitable site for cryopreserved ovarian tissue transplantation? Live births have resulted from oocytes aspirated from follicles within cryopreserved ovarian tissue transplanted in a sub-peritoneal abdominal site with similar outcomes observed in terms of number of mature oocytes recovered and embryo development from tissue transplanted to sub-peritoneal abdominal, ovarian, and pelvic sites in our clinic. Over 130 live births have been reported from cryopreservation of ovarian tissue and subsequent transplantation. In the majority of these, tissue was transplanted onto the remaining ovary. Although grafting to a non-ovarian, non-pelvic, sub-peritoneal abdominal site has resulted in births, it has been suggested that compromised outcomes may be expected from a non-pelvic site. The aim of the study was to assess the outcome from cryopreserved ovarian tissue transplanted to a site out of the pelvic area; a sub-peritoneal abdominal site. These outcomes were compared to transplantation to the ovary and peritoneal pelvic area in a cohort of 17 fertility preservation women where the individual sites of follicle aspiration were known and subsequent outcomes tracked. Ovarian tissue was slow frozen using the cryoprotectants propanediol and sucrose (n = 16 women) or using dimethyl sulfoxide and sucrose (n = 1 woman). Tissue was kept at 4°C overnight prior to freezing for 1 case. Tissue was thawed appropriately and prepared on 6.0 vicryl sutures for transplantation. Tissue was placed laparoscopically into a sub-peritoneal abdominal site, a pelvic side wall peritoneal pocket and the ovary. Following resumption of cycling, gonadotrophin stimulation commenced with FSH, LH and antagonist and a trigger was given when one follicle was >13 mm in diameter. Abdominal follicles were aspirated under ultrasound guidance trans-abdominally; ovarian and pelvic follicles were aspirated trans-vaginally. Due to an inability to differentiate pelvic from ovarian follicles at the time of ultrasound-guided oocyte retrieval, both were classified as ovarian on the side where both were present. However, on the side, where no ovary was present, outcomes from pelvic follicles were reported. Average time lapse between ovarian tissue harvest and graft was 6 years. Resumption of cycling occurred on average 4.2 months post first graft, regardless of graft site. Mean follicle diameter on the day of oocyte aspiration was 14 mm for all sites. Aspiration failed to retrieve an oocyte in 30% (36/120) of abdominal follicles which was similar to the other sites; ovarian 24% (21/87), pelvic 32% (31/97). A similar proportion of retrieved oocytes was mature from all sites (67% (50/75) abdominal, 68% (42/62) ovarian, 59% (34/58) pelvic). The proportion of embryos which developed on Day 2 from those fertilized was also similar in all groups (90% (34/38) abdominal, 76% (22/29) ovarian, 96% (22/23) pelvic). To our knowledge, this is the first report of outcomes from cryopreserved ovarian tissue transplanted to a sub-peritoneal abdominal site and the subsequent comparison to outcomes from the ovary and a sub-peritoneal pelvic graft, within the same cohort of patients, where tissue was slow frozen predominantly with the cryoprotectant propanediol and sucrose. The study reports outcomes from a small number of women following ovarian tissue transplantation. Follicle density is an estimate only and the amount of tissue grafted varied between patients. The demonstration of successful outcomes from cryopreserved ovarian tissue grafted to a sub-peritoneal abdominal site has significant implications for the management of women in which grafting to pelvic sites is contraindicated although it appears to be important to trigger follicle maturation at a lower than normal follicular diameter. The relative ease of oocyte retrieval at the sub-peritoneal abdominal site also has positive implications for the introduction of this approach into clinical practice. No specific funding was used. All authors have no conflict of interest. N/A.

Paracervical Block for Oocyte Retrieval: Experience at a Public Health Facility in Nigeria

Background: Transvaginal Ultrasound Guided Oocyte Retrieval(TUGOR) for in vitro fertilization is one of the most common minorsurgical procedures. Despite this, it is stressful and painful for thepatient and thus requires some form of analgesia with or without sedation. The effects of various anesthetic techniques used for TUGORon reproductive outcomes remain controversial.Aims: This study assessed patients’ perception of pain using paracervical block and its effect on IVF outcomes.Methods: A cross sectional study of 66 eligible patients that underwent assisted reproduction program in our facility. All clients weretreated with antagonist protocol for Controlled Ovarian Hyperstimulation. Self- administered questionnaires was used as the research instrument. Pain was assessed using a 10cm Visual Analogue Scale whileclients’ overall satisfaction was rated using Likert scoring system.Results: Client’s aged 32.8 ±3.4. More than half had primary infertility with mean duration of 4.6 ± 2.4. Female factor infertility wasthe commonest cause of infertility. The pregnancy rate per embryotransfer was 36.4%, miscarriage rate was 9.1%, while the live ratewas 27.3%. The mean VAS scores at 1hour, 6 hours, 24 hours andat embryo transfer were 7.1 ± 2.8, 4.6 ±1.4, 2.8 ±1.2 and 1.0 ± 0.9respectively. The mean Likert score was 2.4 ± 0.9.Conclusion:Paracervical block is a safe and effective anaesthesia/analgesia option for TUGOR.However a multimodal approach of analgesia/anaesthesia for TUGOR is recommended to further improve on clients’ satisfaction andacceptance.

Transabdominal ultrasound guided oocyte retrieval using vaginal ultrasound probe: Definition of the technique.

To define whether transabdominal ultrasound guided oocyte retrieval (TUGOR) is a feasible, effective and safe method. A total of 64 patients who underwent TUGOR in a tertiary referral university hospital in vitro fertilization (IVF) clinic were enrolled. Indications, total number of oocytes collected, total number and percentage of mature oocytes, duration of procedure, complication rates and total number of fertilized oocytes were assessed. The indications for TUGOR were as follows; virgin women with decreased ovarian reserve who opted fertility preservation (n = 52, 81.1%), Ewing Sarcoma (n = 1, 1.56%), breast cancer (n = 4, 6.2%), lymphoma (n = 1, 1.56%) endometrioma (n = 1, 1.56%), immature teratoma of the ovary (n = 1, 1.56%), multiple large uterine fibroids (n = 2, 3.1%), adnexal transposition due to bowel surgery (n = 1, 1.56%) and Mayer Rokitansky Küster Hauser Syndrome (n = 1, 1.56%). Total number of oocytes retrieved and mean number of oocytes collected were 315 and 4.92 ± 1.7 (range 1-21), respectively. The mean duration of the procedure was 12.4 ± 1.2 min. The number and percentage of mature oocytes were 272 and 86.3%, respectively. A total of 14 embryos were frozen in four patients and one blastocyst transfer was performed ending up with live birth. Superficial epigastric artery injury occurred in two patients and resolved spontaneously. No oocyte was retrieved in five patients with single growing follicle in the first attempt. TUGOR is a feasible, effective and safe method of oocyte retrieval for the purpose of fertility preservation or in patients with inaccessible ovaries via transvaginal route undergoing IVF.

Tetracaine combined with propofol for painless oocyte retrieval: from a single center study.

In vitro fertilization-embryo transfer is a main assisted reproductive technique that can improve the success rate of conception. At present, the ultrasound-guided oocyte retrieval is often employed in clinics, but this process will cause pain and fear in outpatients. This study explored the safety and satisfaction of patients who received egg retrieval under vaginal topical tetracaine anesthesia combined with intravenous propofol anesthesia. Patients who underwent elective egg retrieval in the Reproductive Center of Shanghai Tenth People's Hospital were recruited from January 2017 to August 2018 [tetracaine + propofol group (n=53); propofol group (n=48)]. Results showed that tetracaine combined with propofol anesthesia could effectively reduce the dose of propofol during surgery, ensure the quality of follicles, effectively reduce the postoperative pain and improve the operational satisfaction without affecting the prognosis. Our findings provide evidence for further clinical applications of this technique.

A Massive Primary Ovarian Abscess within an Endometrioma in a Young Nullipara – An Unusual Case and Review of Literature

Primary ovarian abscess without the involvement of the fallopian tube is a rare complication of an underlying endometrioma. Surgical interventions like ultrasound guided oocyte retrieval in in vitro fertilization and endometrioma aspiration may be a possible source of infection. De novo primary ovarian abscess within an endometrioma in the absence of a risk factor is even rarer. Decreased natural killer cell activity leads to a failure to clear out the ectopic endometrial tissue and the collected blood acts as a potential culture medium for the growth of pathogenic microorganisms. Infected ovarian endometrioma is a surgical emergency and preserving the fertility in a nullipara is a challenge. We report an unusual case of a massive de novo ovarian abscess masking an endometrioma in a young nulliparous woman with no risk factors. We have summarized current literature and evaluated the etiopathogenesis and the risk factors leading to abscess formation within an endometrioma.

A Patient with Tubo-Ovarian Abscess with Endometriosis after Transvaginal Oocyte Retrieval

Ultrasound-guided oocyte retrieval is a standard procedure for ovum pick up (OPU) during in vitro fertilization. Possible complications include tubo-ovarian abscesses (TOAs) in the fallopian tubes, and endometriosis may be associated with increasing the severity of pelvic infection. A 35-year-old woman who had been treated for infertility and endometriosis presented with abdominal pain that appeared several days after OPU. There were no significant changes in the size of both ovaries and fallopian tubes. A week later, transvaginal echography revealed right oviduct enlargement. Because conservative treatment with antibiotics before this revelation had not been successful, laparoscopy was performed for abscess drainage and/or excision of the adnexa. Intraoperative findings were an abscess in the right adnexa involving the ovary and fallopian tube. Preservation of the right fallopian tube was difficult due to the risk of prolonged infection, and a right appendectomy was performed. The diagnosis was a right TOA. Severe cases of pelvic infection after OPU may cause infertility. The presence of endometriosis may aggravate the infection, but the relationship between the extent of the endometriosis and the severity of the infection is not known. Even if the endometriosis is mild, as it was in this patient, surgical treatment should be considered if a severe infection occurs after OPU and conservative treatment is not effective.

Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil – A randomized clinical trial

ObjectiveAnesthesia for assisted reproductive technology is very important to provide less stressful and painful environment for patients, with minimal side effects on oocytes. In the present study, we aimed to evaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcome among patients underwent anesthesia with fentanyl, remifentanil or alfentanil. Material and methodsThis randomized double-blinded clinical trial was conducted in patients undergoing anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomly allocated to alfentanil (A; 15 μg/kg), fentanyl (F; 1.5 μg/kg) or remifentanil (R; 1.5 μg/kg) groups. ResultsThree hundred forty patients were assessed for eligibility and randomized for transvaginal oocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significant differences were noted among groups regarding basic characteristics. Although, time to respond to verbal command was significantly different among groups (A: 1.99 ± 1.64, F: 2.56 ± 1.72, R: 1.78 ± 1.34, P = 0.014). There were no significant differences among groups with respect to the first and second postoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolic blood pressure (BP). Terminal systolic (A: 101.61 ± 9.15, F: 105.29 ± 12.61, R: 102 ± 12.91, P = 0.01) and diastolic (A: 59.97 ± 9, F: 65.63 ± 9.13, R: 63.69 ± 11.01, P = 0.003) BP was significantly different among groups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%, P = 0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups. ConclusionsThe results of present study demonstrated that all three opioids have the same efficiency, in regards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil compared with fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rate and less hemodynamic stability. Registration numberIRCT201410258677N4.

Altered expression of the kisspeptin/KISS1R and neurokinin B/NK3R systems in mural granulosa and cumulus cells of patients with polycystic ovarian syndrome

The neurokinin B (NKB)/NK3 receptor (NK3R) and kisspeptin (KISS1)/kisspeptin receptor (KISS1R), two systems essential for reproduction, are present in human granulosa cells (GCs) of healthy women and contribute to the control of fertility, at least partially, by acting on the gonads. However, little is known about the expression of these systems in GCs of women with polycystic ovarian syndrome (PCOS). The aim of this study was to analyze the expression of NKB/NK3R and KISS1/KISS1R in mural granulosa (MGCs) and cumulus cells (CCs) of PCOS women. A cross-sectional study was performed in 46 healthy women and 43 PCOS women undergoing controlled ovarian stimulation. MGCs and CCs were collected from pre-ovulatory follicles after transvaginal ultrasound-guided oocyte retrieval and the expression of the genes encoding NKB (TAC3), NK3R (TACR3), KISS1, and its receptor (KISS1R) was analyzed using real-time quantitative RT-PCR. TAC3, TACR3, and KISS1 mRNA levels were decreased in MGCs and CCs of PCOS women. TAC3 positively correlated with KISS1 in MGCs of healthy women and TACR3 was positively associated with KISS1R in CCs from healthy women. These associations were not observed in PCOS women. The NKB/NK3R and KISS1/KISS1R systems are dysregulated in MGCs and CCs of PCOS women. The lower expression of these systems in GCs could contribute to the abnormal follicle development and defective ovulation that characterize the pathogenesis of PCOS.

The impact of music therapy on pain and stress reduction during oocyte retrieval - a randomized controlled trial.

Does music therapy help in reducing pain and anxiety in women undergoing transvaginal ultrasound-guided oocyte retrieval (TUGOR)? In this randomized controlled open label study, 209 participants were recruited and randomized into three groups (music group, n = 70; headphone group, n = 70; control group, n = 69). Patients' psychological status was assessed using the visual analogue scale of pain (VAS-P), satisfaction of pain control, state-trait anxiety inventory (STAI), Beck depression inventory (BDI), and general health questionnaire (GHQ). Stress biomarkers, including salivary alpha amylase (sAA) and salivary cortisol (sCort), were measured before and after TUGOR. No significant differences were found in psychological scoring of STAI, BDI, GHQ and the stress biomarkers. Although neither the anxiety scores nor the analgesic requirements differed among the three groups, the visual measure of vaginal pain (median, range) showed music group (20,0-70) was significantly (P = 0.005) lower than headphone group (30,0-90) and control group (30,0-100). The degree of satisfaction with pain control (median, range) in the music group (80,30-100), was significantly (P = 0.001) higher than the headphone group (80,10-100) and control group (70,0-100). Music is a simple, inexpensive and effective way to reduce pain score and increase satisfaction with pain control during TUGOR procedure, which may justify its routine use.

Differing molecular response of young and advanced maternal age human oocytes to IVM.

What effect does maternal age have on the human oocyte's molecular response to in vitro oocyte maturation? Although polyadenylated transcript abundance is similar between young and advanced maternal age (AMA) germinal vesicle (GV) oocytes, metaphase II (MII) oocytes exhibit a divergent transcriptome resulting from a differential response to in vitro oocyte maturation. Microarray studies considering maternal age or maturation stage have shown that either of these factors will affect oocyte polyadenylated transcript abundance in human oocytes. However, studies considering both human oocyte age and multiple stages simultaneously are limited to a single study that examined transcript levels for two genes by qPCR. Thus, polyadenylated RNA sequencing (RNA-Seq) could provide novel insight into age-associated aberrations in gene expression in GV and MII oocytes. The effect of maternal age (longitudinal analysis) on polyadenylated transcript abundance at different stages was analyzed by examining single GV and single in vitro matured MII oocytes derived from five young (YNG; < 30 years; average age 26.8; range 20-29) and five advanced maternal age (AMA; ≥40 years; average age 41.6 years; range 40-43 years) patients. Thus, a total of 10 YNG (5 GV and 5 MII) and 10 AMA (5 GV and 5 MII) oocytes were individually processed for RNA-Seq analysis. Patients undergoing infertility treatment at the Colorado Center for Reproductive Medicine (Lone Tree, CO, USA) underwent ovarian stimulation with FSH and received hCG for final follicular maturation prior to ultrasound guided oocyte retrieval. Unused GV oocytes obtained at retrieval were donated for transcriptome analysis. Single oocytes were stored (at -80°C in PicoPure RNA Extraction Buffer; Thermo Fisher Scientific, USA) immediately upon verification of immaturity or after undergoing in vitro oocyte maturation (24 h incubation), representing GV and MII samples, respectively. After isolating RNA and generating single oocyte RNA-Seq libraries (SMARTer Ultra Low Input RNA HV kit; Clontech, USA), Illumina sequencing (100 bp paired-end reads on HiSeq 2500) and bioinformatics analysis (CLC Genomics Workbench, DESeq2, weighted gene correlation network analysis (WGCNA), Ingenuity Pathway Analysis) were performed. A total of 12 770 genes were determined to be expressed in human oocytes (reads per kilobase per million mapped reads (RPKM) > 0.4 in at least three of five replicates for a minimum of one sample type). Differential gene expression analysis between YNG and AMA oocytes (within stage) identified 1 and 255 genes that significantly differed (adjusted P < 0.1 and log2 fold change >1) in polyadenylated transcript abundance for GV and MII oocytes, respectively. These genes included CDK1, NLRP5 and PRDX1, which have been reported to affect oocyte developmental potential. Despite the similarity in transcript abundance between GV oocytes irrespective of age, divergent expression patterns emerged during oocyte maturation. These age-specific differentially expressed genes were enriched (FDR < 0.05) for functions and pathways associated with mitochondria, cell cycle and cytoskeleton. Gene modules generated by WGCNA (based on gene expression) and patient traits related to oocyte quality (e.g. age and blastocyst development) were correlated (P < 0.05) and enriched (FDR < 0.05) for functions and pathways associated with oocyte maturation. Raw data from this study can be accessed through GSE95477. The human oocytes used in the current study were obtained from patients with varying causes of infertility (e.g. decreased oocyte quality and oocyte quality-independent factors), possibly affecting oocyte gene expression. Oocytes in this study were retrieved at the GV stage following hCG administration and the MII oocytes were derived by IVM of patient oocytes. Although the approach has the benefit of identifying intrinsic differences between samples, it may not be completely representative of in vivo matured oocytes. Transcriptome profiles of YNG and AMA oocytes, particularly at the MII stage, suggest that aberrant transcript abundance may contribute to the age-associated decline in fertility. J.M.R. was supported by an Austin Eugene Lyons Fellowship awarded by the University of California, Davis. The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (awarded to P.J.R.; R01HD070044) and the Fertility Laboratories of Colorado partly supported the research presented in this manuscript.