title: Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome.
abstract: OBJECTIVE
  To report the first case series of ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration (TVOA).
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  In vitro fertilization unit of a tertiary university hospital.
  
  
  METHODS
  Patients who underwent TVOA during a 6-year period.
  
  
  METHODS
  Surgical intervention due to active bleeding from the ovary.
  
  
  METHODS
  Prevalence and risk factors.
  
  
  RESULTS
  Among 3,241 patients undergoing TVOA, 7 were diagnosed as having ovarian hemorrhage afterward. All patients were thin, with a body mass index of 19-21 kg/m(2), and 4 had polycystic ovary syndrome (PCOS). The prevalence of ovarian bleeding among lean patients with PCOS was 4.5%. The odds ratio for bleeding in lean patients with PCOS vs. all other patients was 50 (95% confidence interval 11-250). The interval between the TVOA and surgical intervention ranged from 5 to 18 hours (mean +/- SD, 11.4 +/- 5 hours). The Delta decrease in hemoglobin levels was 3.2-9 g/dL (mean 6.1 +/- 1.8). In 6 of the 7 patients, laparoscopically guided electrocoagulation was sufficient to achieve hemorrhagic control.
  
  
  CONCLUSIONS
  Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.
authors.affiliation: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, P.O. Box 3235, Jeusalem 91031, Israel. liberg2@gmail.com
authors.forename: Gad
authors.initials: G
authors.lastname: Liberty
authors.forename: Jordana Hadassah
authors.initials: JH
authors.lastname: Hyman
authors.forename: Talia
authors.initials: T
authors.lastname: Eldar-Geva
authors.forename: Boris
authors.initials: B
authors.lastname: Latinsky
authors.forename: Michael
authors.initials: M
authors.lastname: Gal
authors.forename: Ehud J
authors.initials: EJ
authors.lastname: Margalioth
mesh_terms: D000208:Acute Disease; D000328:Adult; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001835:Body Weight; D002388:Catastrophic Illness / Q000453:epidemiology; D005260:Female; D005307:Fertilization in Vitro; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000628:therapy*; D054315:Oocyte Retrieval / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D010053:Ovary / Q000000981:diagnostic imaging; D011085:Polycystic Ovary Syndrome / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014621:Vagina; D055815:Young Adult