Bladder hematoma: a complication from an oocyte retrieval procedure

Abstract

Introduction: More than one million fertilization cycles are performed every year. The incidence of serious complications associated with transvaginal oocyte pick-up is low, but the procedure is not risk-free. Risks are inherent to procedures in which thin needles and sharp instruments are introduced into the vaginal wall and ovarian capsule to access the ovaries.Case Description: A 45-year-old patient reported urinary discomfort and difficulty urinating after her second cycle, 12 hours after oocyte pick-up. She had visible hematuria with small blood clots. Transvaginal ultrasound examination performed 24 hours after pick-up showed a heterogeneous intravesical image suggestive of a clot; her bladder measured 23x19mm. She was afebrile and in good condition. The patient was managed conservatively and offered fluids. The clot was expelled within a matter of hours. This case of a bladder hematoma was the first in the 21 years of a clinic where all procedures are guided by ultrasonography with clear visualization of the tip of the needle throughout the 15-20 minutes of the procedure. Patients submitted to ultrasound-guided transvaginal oocyte pick-up procedures in IVF protocols must be informed of this rare potential complication.

Bladder Haematoma: A Rare but Serious Complication of Oocyte Retrieval

“…Souza et al . [ 4 ] reported a urological complications rate of 0.03% in over 2739 procedures, which was similar to our rate of 0.04% in over 4835 procedures.…”

“…In a case report by Souza et al . [ 4 ] patient presented within 12 h of oocyte retrieval with complaints of haematuria along with blood clots. TVS revealed a heterogeneous intravesical mass suggestive of clot 22 mm × 19 mm, which was managed conservatively.…”

The Mare: A Pertinent Model for Human Assisted Reproductive Technologies?

“…The OPU procedure is generally very well tolerated in both women and mares [ 97 , 99 , 104 , 105 , 106 ]. In horses, it can be repeated every two weeks in routine management [ 106 ].…”

Intravesical Agents in the Treatment of Bladder Clots in Children

“…Other authors, in case of Ellik failure, have proposed continuous mechanical suction [ 16 , 17 , 18 ]. In women, in rare cases, small blood clots may be spontaneously expelled thanks to an increased fluid intake, due to a shorter and wider urethra in females [ 19 ]. When urethral catheterization is impossible (e.g., trauma, children), a percutaneous suprapubic tube or endoscopy may be considered [ 20 ] and may improve and speed up the conventional trans-urethral technique [ 21 ].…”