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

Abstract

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.

Tubo-ovarain abscess in patient with ovarian endometriosis

“…4 Previous surgical procedures involving the pelvic organs have been found to increase the risk of tubo-ovarian abscess formation in the patients with the endometriosis. 7 In study done by Mabrouk et al found that preoperative hormone intervention can shrink the endometriosis lesion and reduce inflammation through ovarian inactivation, down-regulate cell proliferation, and increase the apoptosis of endometriosis tissues. 8 Tas et al found that endometriosis with TOA is not only seen in reproductive period but also in menopause, more prevalent than expected for normal population.…”