Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Fawaz Edris, Nelson Holiva, Salma Baghdadi, Mamdoh Eskandar, Angelos A Vilos, Wardah Alasmari1 and George A Vilos
Objectives: To described the feasibility, relative safety and efficacy of a modified transabdominal ultrasoundguided follicular-aspiration technique.
Methods: Retrospective cohort study in a private In-Vitro Fertilization (IVF) center. Amongst 816 IVF cycles over 3 years, 13 women (13 cycles) with inaccessible ovaries through the vagina required transabdominal retrieval. In 3 cases, both ovaries were aspirated transabdominally. Under conscious sedation and local analgesia, the same operator scanned the abdomen with one hand and retrieved the oocytes with the other; using a standard 17-gauge aspiration needle and without the use of a needle-guide. All but one ovary required one puncture. Research board of ethics approval was obtained.
Results: The mean and standard deviation (± SD) number of oocytes retrieved transabdominally and transvaginally were 8.4 (± 4.8) and 10.5 (± 6.8), respectively (P=0.93). The mean (± SD) fertilization rate and “good quality” embryos was 78.1% (± 16.2) and 51.9% (± 19.8), respectively. Of the 13 patients, 12 had Embryo Transfer (ET). One patient developed ovarian hyperstimulation syndrome and her embryos were cryopreserved. Of the 12 patients, one had an ectopic pregnancy and 6 (50%) had at least one intrauterine gestational sac. Two patients conceived with a twin and four with a singleton. One of the twin cases aborted at 19 weeks due to an incompetent cervix, and one singleton pregnancy had a miscarriage at 8 weeks of gestation. The other four patients (33.3%) delivered at term, and all babies are alive and well. Of the remaining 5 patients, one conceived from a frozen ET, and delivered a healthy baby at term.
Conclusion: This modified technique, performed by a single operator under conscious sedation and local analgesia, allowed maximal retrieval of oocytes through a single ovarian puncture in women undergoing IVF-ET with inaccessible ovaries transvaginally. It is safe and feasible.