Evaluation of complications developing during and after transvaginal ultrasound — guided oocyte retrieval

Ozaltin, Selin; Kumbasar, Serkan; Savan, Kadir

doi:10.5603/gp.a2018.0001

Cited by 21 publications

(17 citation statements)

References 27 publications

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“…Factors associated with an increased risk of bleeding include previous surgery ( Levi-Setti et al , 2018 ) and coagulation disorders ( El-Shawarby et al , 2004 ; Moayeri et al , 2007 ). Pelvic organ (bowel, bladder, ureters) injury is a quite rare complication, with an incidence of 0.01–0.1% ( Miller et al , 2002 ; Fiori et al , 2006 ; Ludwig et al , 2006 ; Bozdag et al , 2008 ; von Eye Corleta et al , 2008 ), while pelvic infections range from 0.04% to 0.77% ( Levi-Setti et al , 2018 ; Ozaltin et al , 2018 ). Severe pain requiring hospitalization is reported to occur in 0.06% to 0.7% of the cases ( Ludwig et al , 2006 ; Levi-Setti et al , 2018 ; Ozaltin et al , 2018 ).…”

Section: Resultsmentioning

confidence: 99%

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Vlaisavljević¹,

Apter

Capalbo

et al. 2021

Human Reproduction Open

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STUDY QUESTION Is it possible to define a set of performance indicators (PIs) for clinical work in ART, which can create competency profiles for clinicians and for specific clinical process steps? SUMMARY ANSWER The current paper recommends six PIs to be used for monitoring clinical work in ovarian stimulation for ART, embryo transfer, and pregnancy achievement: cycle cancellation rate (before oocyte pick-up (OPU)) (%CCR), rate of cycles with moderate/severe ovarian hyperstimulation syndrome (OHSS) (%mosOHSS), the proportion of mature (MII) oocytes at ICSI (%MII), complication rate after OPU (%CoOPU), clinical pregnancy rate (%CPR), and multiple pregnancy rate (%MPR). WHAT IS KNOWN ALREADY PIs are objective measures for evaluating critical healthcare domains. In 2017, ART laboratory key PIs (KPIs) were defined. STUDY DESIGN, SIZE, DURATION A list of possible indicators was defined by a working group. The value and limitations of each indicator were confirmed through assessing published data and acceptability was evaluated through an online survey among members of ESHRE, mostly clinicians, of the special interest group Reproductive Endocrinology. PARTICIPANTS/MATERIALS, SETTING, METHODS The online survey was open for 5 weeks and 222 replies were received. Statements (indicators, indicator definitions, or general statements) were considered accepted when ≥70% of the responders agreed (agreed or strongly agreed). There was only one round to seek levels of agreement between the stakeholders. Indicators that were accepted by the survey responders were included in the final list of indicators. Statements reaching less than 70% were not included in the final list but were discussed in the paper. MAIN RESULTS AND THE ROLE OF CHANCE Cycle cancellation rate (before OPU) and the rate of cycles with moderate/severe OHSS, calculated on the number of started cycles, were defined as relevant PIs for monitoring ovarian stimulation. For monitoring ovarian response, trigger and OPU, the proportion of MII oocytes at ICSI and complication rate after OPU were listed as PIs: the latter PI was defined as the number of complications (any) that require an (additional) medical intervention or hospital admission (apart from OHSS) over the number of OPUs performed. Finally, clinical pregnancy rate and multiple pregnancy rate were considered relevant PIs for embryo transfer and pregnancy. The defined PIs should be calculated every 6 months or per 100 cycles, whichever comes first. Clinical pregnancy rate and multiple pregnancy rate should be monitored more frequently (every 3 months or per 50 cycles). Live birth rate (LBR) is a generally accepted and an important parameter for measuring ART success. However, LBR is affected by many factors, even apart from ART, and it cannot be adequately used to monitor clinical practice. In addition to monitoring performance in general, PIs are essential for managing the performance of staff over time, and more specifically the gap between expected performance and actual performance measured. Individual clinics should determine which indicators are key to the success in their organisation based on their patient population, protocols, and procedures, and as such, which are their KPIs. LIMITATIONS, REASONS FOR CAUTION The consensus values are based on data found in the literature and suggestions of experts. When calculated and compared to the competence/benchmark limits, prudent interpretation is necessary taking into account the specific clinical practice of each individual centre. WIDER IMPLICATIONS OF THE FINDINGS The defined PIs complement the earlier defined indicators for the ART laboratory. Together, both sets of indicators aim to enhance the overall quality of the ART practice and are an essential part of the total quality management. PIs are important for education and can be applied during clinical subspecialty. STUDY FUNDING/COMPETING INTEREST(S) This paper was developed and funded by ESHRE, covering expenses associated with meetings, literature searches, and dissemination. The writing group members did not receive payment. Dr G.G. reports personal fees from Merck, MSD, Ferring, Theramex, Finox, Gedeon-Richter, Abbott, Biosilu, ReprodWissen, Obseva, PregLem, and Guerbet, outside the submitted work. Dr A.D. reports personal fees from Cook, outside the submitted work; Dr S.A. reports starting a new employment in May 2020 at Vitrolife. Previously, she has been part of the Nordic Embryology Academic Team, with meetings were sponsored by Gedeon Richter. The other authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHREs recommendations do not constitute or imply the endorsement, recommendation, or favouring of any of the included technologies by ESHRE.

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Section: Resultsmentioning

confidence: 99%

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Vlaisavljević¹,

Apter

Capalbo

et al. 2021

Human Reproduction Open

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“…[ 2 ] One study reported that 59.5% of patients experienced pain during oocyte retrieval. [ 3 ] Other studies also confirmed that more than half of the women suffer pain during oocyte retrieval. [ 4 , 5 ] Moreover, pelvic organs and blood vessels can be damaged by aspiration needles, and life-threatening complications related to infection or anesthesia may occur.…”

Section: Introductionmentioning

confidence: 87%

“…[ 17 , 18 ] These analgesia methods can relieve pain, but may cause nausea, vomiting, dizziness, suppression of the nervous system, possible impairment of respiration or blood circulation and other adverse reactions. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Acupuncture for pain relief of women undergoing transvaginal oocyte retrieval

Guo

Li²,

Wei³

et al. 2020

Medicine

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Background: Pain during oocyte retrieval, which can make the in-vitro fertilization process an unpleasant experience, is becoming a common problem. Although there are many analgesic methods available in the clinical setting, they are not therapeutically equivalent, and some are associated with varying adverse reactions. In recent years, acupuncture analgesia has been used in the perioperative period of oocyte retrieval because of its perceived efficacy and safety. The purpose of this systematic review and meta-analysis is to provide evidence that acupuncture is effective in the treatment of vaginal oocyte retrieval pain. Methods: Electronic searches of the following six databases will be conducted by two qualified reviewers: MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Medicine database, VIP database and Wanfang database. Three clinical trial registries will also be searched: World Health Organization International Clinical Trial Registry Platform, Chinese Clinical Trial Registry, Cochrane Central Register of Controlled Trials and ClinicalTrials.Gov. All searches will cover the period from inception of the database/registry to March 2020 and will be limited to publications in English and Chinese. Data identification, data selection, data extraction, and bias risk assessment will be conducted independently by3ν two or more qualified reviewers, including those who selected the studies. Visual analogue scale scores will be calculated as the primary outcome. Secondary outcomes will include results of other subjective pain rating scales, including Likert scales or other defined numerical or non-numerical scales, self-assessed by patients before, during, and after oocyte retrieval. We will use STATA software (Version 16) to perform meta-analyses, and the Grading of Recommendations, Assessment, Development and Evaluations framework to grade the quality of evidence. If quantitative analysis is not available, a systematic narrative synthesis will be provided. PROSPERO registration number: CRD42020170095.

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“…Large observational studies have also been conducted (Table III). Overall, the incidence and severity of the reported complications are low (Ludwig et al., 2006; Aragona et al., 2011; Siristatidis et al., 2013; Ozaltin et al., 2018).…”

Section: Recommendationsmentioning

confidence: 97%

“…Apart from data collection and observational studies (Ludwig et al., 2006, Aragona et al., 2011, Siristatidis et al., 2013, Ozaltin et al., 2018), most reports on serious complications during and after OPU have been published in case reports (Table IV). Reported complications include bleeding, infection, urinary tract injury and pseudoaneurysm.…”

Section: Recommendationsmentioning

confidence: 99%

Recommendations for good practice in ultrasound: oocyte pick up†

D’Angelo

Panayotidis

Amso

et al. 2019

Human Reproduction Open

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STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS, SETTING, METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS, REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA. ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

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Evaluation of complications developing during and after transvaginal ultrasound — guided oocyte retrieval

Cited by 21 publications

References 27 publications

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

Acupuncture for pain relief of women undergoing transvaginal oocyte retrieval

Recommendations for good practice in ultrasound: oocyte pick up†

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