Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome.
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.
Liberty
Gad
G
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, P.O. Box 3235, Jeusalem 91031, Israel. liberg2@gmail.com
Hyman
Jordana Hadassah
JH
Eldar-Geva
Talia
T
Latinsky
Boris
B
Gal
Michael
M
Margalioth
Ehud J
EJ
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