Minimizing the Risk of Infection and Bleeding at Trans-Vaginal Ultrasound-Guided Ovum Pick-up: Results of a Prospective Web-Based World-Wide Survey

Abstract

Objective The objective of this study was to identify clinical practices worldwide, which would help in recognizing women at risk of excessive bleeding or of developing pelvic infection following trans-vaginal ovum pick-up (TV-OPU), measures taken to minimize risks and their management. 123Method A prospective, web-based questionnaire with distinct questions related to the practice of TV-OPU. Results A total of 155 units from 55 countries performing 97,200 IVF cycles annually responded to this web-based survey. A majority (65 %) responded that they would routinely carry out full blood count, while 35 % performed coagulation profile. Less than a third agreed screening women for vaginal infections. About a third used both sterile water and antiseptic to minimize ascending infection, and 52 % used antibiotics for prophylaxis. Doppler ultrasound was routinely used by 20 % of clinicians. 73 % of the clinicians preferred conservative management as their first line management for patients diagnosed with intra-abdominal bleeding. Conclusion The study has identified a wide variation in the practices of minimizing infection and bleeding complications. The dearth of good quality evidence may be responsible for the lack of published guidelines, and therefore a lack of consensus on the optimum practice for minimizing the risk of infection and bleeding during TV-OPU.

Oocyte retrieval difficulties in women with ovarian endometriomas

“…Oocyte retrieval was performed transvaginally 36 hours later. Even if the benefits of the prophylaxis with antibiotics remains debated (Bhandari et al, 2015;Kaye et al, 2017), the policy of our unit was to systematically administer Ceftriaxone 2 g intravenously (Clarithromycin 500 mg for women who were allergic) at the time of the retrieval.…”

Complications of assisted reproductive technology treatment and the factors influencing reproductive outcome

“…Transvaginal oocyte retrieval (TVOR) is a relatively safe procedure, but observational studies report it to be associated with complications of minor vaginal bleeding (1.4–18.4%), pelvic infection (0.1–0.6%) and, rarely, with severe intra‐abdominal bleeding (0.05–0.2%) . Though the quoted figures are very small, these complications can cause significant maternal morbidity, thus it is vital to minimise these risks.…”

“…Though the quoted figures are very small, these complications can cause significant maternal morbidity, thus it is vital to minimise these risks. However, a global survey revealed wide variations in the ways that at‐risk women are identified in clinical practice and the measures taken to minimise excessive bleeding and infective complications during TVOR …”

Improving the safety of the embryo and the patient during fertilization procedures.

“…Reduction of the number of insertions of the needle contributes to minimization of the occurrence of hemorrhage or introduction of infection. It is the more difficult the larger the ovary, with which we are confronted, among other situations, during the OHSS [14]. …”