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Sönmezer M, Saçıntı KG, Gülümser Ç, Özkavukçu S, Atabekoğlu C, Şükür YE, Sönmezer M. Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach. J Assist Reprod Genet 2023; 40:399-405. [PMID: 36595090 PMCID: PMC9935757 DOI: 10.1007/s10815-022-02705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We aimed to compare the feasibility, effectiveness, and safety of transabdominal ultrasound-guided oocyte retrieval (TUGOR) using a vaginal probe and traditional vaginal approach in virgin patients undergoing oocyte cryopreservation. METHODS A total of 116 virgin patients who underwent transabdominal ultrasound-guided oocyte retrieval using a vaginal ultrasound probe and 33 patients matched for BMI, antral follicle count, age, day 3 FSH, estradiol, and AMH who underwent vaginal approach were enrolled. Mean number of total oocytes collected, mean number of cryopreserved MII oocytes, duration of the procedure, duration of stimulation, mean gonadotropin consumption, mature oocyte ratio, and a modified follicle-oocyte index were compared between the groups. RESULTS No statistical difference was found between the groups in mean number of follicles > 12 mm (4.62 ± 4.54 vs. 5.44 ± 4.52), mean number of oocytes collected (4.44 ± 4.14 vs. 5.33 ± 4.52), mean number of cryopreserved MII oocytes (4.01 ± 3.67 vs. 4.53 ± 4.13), mean duration of the procedure (12.4 ± 1.2 vs. 13.4 ± 1.6 min), mean days of stimulation (8.05 ± 1.91 vs. 8.35 ± 1.72 days), mean gonadotropin consumption (1507.9 ± 475.3 vs. 1571.74 ± 404.6 units), mature oocyte ratio (0.78 ± 0.24 vs. 0.82 ± 0.26), and modified follicle oocyte index (0.86 ± 0.63 vs. 0.84 ± 0.19). In the TUGOR group, superficial epigastric artery injury occurred in two patients and resolved spontaneously. CONCLUSION Transabdominal oocyte retrieval using a vaginal ultrasound is a safe, effective, and feasible method of oocyte retrieval in some selected patient groups.
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Affiliation(s)
| | - Koray Görkem Saçıntı
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology, Yüksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Sinan Özkavukçu
- Department of Histology and Embryology, Ankara University School of Medicine, Ankara, Turkey
- School of Medicine, Postgraduate Medicine, Ninewells Medicine, Assisted Conception Unit, University of Dundee, Dundee, UK
| | - Cem Atabekoğlu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
- Ankara University Center for Human Reproduction and Infertility, Ankara, Turkey.
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Sönmezer M, Gülümser Ç, Sönmezer M, Sükür YE, Atabekoğlu C. Transabdominal ultrasound guided oocyte retrieval using vaginal ultrasound probe: Definition of the technique. J Obstet Gynaecol Res 2020; 47:800-806. [PMID: 33336548 DOI: 10.1111/jog.14618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/07/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To define whether transabdominal ultrasound guided oocyte retrieval (TUGOR) is a feasible, effective and safe method. METHODS A total of 64 patients who underwent TUGOR in a tertiary referral university hospital in vitro fertilization (IVF) clinic were enrolled. Indications, total number of oocytes collected, total number and percentage of mature oocytes, duration of procedure, complication rates and total number of fertilized oocytes were assessed. RESULTS The indications for TUGOR were as follows; virgin women with decreased ovarian reserve who opted fertility preservation (n = 52, 81.1%), Ewing Sarcoma (n = 1, 1.56%), breast cancer (n = 4, 6.2%), lymphoma (n = 1, 1.56%) endometrioma (n = 1, 1.56%), immature teratoma of the ovary (n = 1, 1.56%), multiple large uterine fibroids (n = 2, 3.1%), adnexal transposition due to bowel surgery (n = 1, 1.56%) and Mayer Rokitansky Küster Hauser Syndrome (n = 1, 1.56%). Total number of oocytes retrieved and mean number of oocytes collected were 315 and 4.92 ± 1.7 (range 1-21), respectively. The mean duration of the procedure was 12.4 ± 1.2 min. The number and percentage of mature oocytes were 272 and 86.3%, respectively. A total of 14 embryos were frozen in four patients and one blastocyst transfer was performed ending up with live birth. Superficial epigastric artery injury occurred in two patients and resolved spontaneously. No oocyte was retrieved in five patients with single growing follicle in the first attempt. CONCLUSION TUGOR is a feasible, effective and safe method of oocyte retrieval for the purpose of fertility preservation or in patients with inaccessible ovaries via transvaginal route undergoing IVF.
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Affiliation(s)
- Murat Sönmezer
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology, Yuksek Ihtisas University Faculty of Medicine, Ankara, Turkey
| | | | - Yavuz Emre Sükür
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cem Atabekoğlu
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
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Garg D, Grazi R, Kankanala N, Melzer-Ross K. Bilateral ovarian maldescent: Unusual cause of infertility - A case report and literature review. J Obstet Gynaecol Res 2016; 42:1038-41. [PMID: 27094464 DOI: 10.1111/jog.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/06/2016] [Indexed: 11/29/2022]
Abstract
Infertility due to ovarian maldescent is extremely rare and diagnosis can be challenging in the absence of uterine anomalies. We present a case of infertility due to bilateral ovarian maldescent with normal uterine anatomy who conceived after in vitro fertilization and did not require removal of the ovaries. A 19-year-old woman presented with primary infertility. After three failed cycles of ovulation induction/intrauterine insemination and one failed cycle of fresh embryo transfer, the patient underwent laparoscopy, which showed bilateral ovaries above the pelvic brim. The patient conceived after second in vitro fertilization and delivered at 34 weeks. Accurate diagnosis of ovarian maldescent in a patient of unexplained infertility and normal uterus is crucial for successful follicular aspiration and infertility treatment. It is important to counsel patients about the benign nature of this rare entity and future fertility.
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Affiliation(s)
- D Garg
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, USA
| | - R Grazi
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, USA
| | - N Kankanala
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, USA
| | - K Melzer-Ross
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, USA
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Comparing transabdominal and transvaginal ultrasound-guided follicular aspiration: A risk assessment formula. Taiwan J Obstet Gynecol 2015; 54:693-9. [DOI: 10.1016/j.tjog.2015.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/20/2022] Open
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Londra L, Chuong FS, Kolp L. Mayer-Rokitansky-Kuster-Hauser syndrome: a review. Int J Womens Health 2015; 7:865-70. [PMID: 26586965 PMCID: PMC4636170 DOI: 10.2147/ijwh.s75637] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The congenital aplasia or severe hypoplasia of mullerian structures is infrequent. However, the features of normal female endocrine function paired with the absence of a functional uterus and vagina makes it a fascinating entity. The diagnosis and work-up in these patients has become very efficient, thanks to the use of imaging, and there are multiple successful procedures for the creation of a neovagina. In recent years, infertility treatment options through in vitro fertilization have also become available as part of the long-term care of these patients.
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Affiliation(s)
- Laura Londra
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Farah S Chuong
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Kolp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
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Friedler S, Grin L, Liberti G, Saar-Ryss B, Rabinson Y, Meltzer S. The reproductive potential of patients with Mayer-Rokitansky-Küster-Hauser syndrome using gestational surrogacy: a systematic review. Reprod Biomed Online 2015; 32:54-61. [PMID: 26626805 DOI: 10.1016/j.rbmo.2015.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
Women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome may reproduce after uterine transplantation or IVF using a gestational surrogate. As uterine transplantation is still an experimental procedure, data on their clinical outcome using assisted reproduction techniques are imperative to allow evidence-based counselling. For this purpose, a systematic non-restricted electronic literature search was conducted. The 14 studies included in this review were published between 1988 and 2011. From a cohort of 140 patients with MRKH syndrome, mostly from the the USA and Israel, only four studies contained data on more than 10 patients; the others were case reports or small series. In the studies reviewed, 125 patients underwent 369 cycles of IVF with gestational surrogacy, and delivered 71 newborns. The reporting of outcome of patients with MRKH syndrome undergoing assisted reproduction techniques in the available literature is less than optimal and is characterized by bias of publication, inconsistent reports, including few patients, treated over a long time span, and lacking systematic reports from large IVF centres. None of the national registries contain specific outcome data on patients with MRKH syndrome. The paucity of data limits the possibility to draw firm conclusions but substantiates the need for a systematic multicentre reporting system.
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Affiliation(s)
- Shevach Friedler
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Leonti Grin
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gad Liberti
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Buzhena Saar-Ryss
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaakov Rabinson
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Semion Meltzer
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hall-Craggs MA, Williams CE, Pattison SH, Kirkham AP, Creighton SM. Mayer-Rokitansky-Kuster-Hauser Syndrome: Diagnosis with MR Imaging. Radiology 2013; 269:787-92. [DOI: 10.1148/radiol.13130211] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Incidence of ovarian maldescent in women with mullerian duct anomalies: evaluation by MRI. AJR Am J Roentgenol 2012; 198:W381-5. [PMID: 22451577 DOI: 10.2214/ajr.11.6595] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the incidence of ovarian mal-descent in patients with and in those without müllerian duct anomalies. MATERIALS AND METHODS Multiplanar MRI examinations of patients with (n = 65) and those without (n = 64) congenital uterine anomalies were evaluated for ovarian size, position, follicle count, and associated renal anomalies. Patients who were pregnant, had known prior pelvic surgery, or had large uterine leiomyomas were excluded. Two criteria were used to determine ovarian malposition: Was the upper pole of the ovary above the pelvic brim, as defined by the pubic symphysis-sacral promontory line, or was the upper pole of the ovary at or above the iliac artery bifurcation? RESULTS The müllerian duct anomalies identified in the study group included hypoplasia, unicornuate, didelphys, bicornuate, and septate uterus. Ovarian maldescent was identified in 12 of 65 women with uterine anomalies (17%) as compared with two of 64 women with normal uterine anatomy (3%) using the criterion of the ovarian pole being above the iliac bifurcation. Among the women with müllerian duct anomalies, only three of 29 with septate uterus (10%) had ovarian maldescent compared with the remaining nine of 36 women with other anomalies (25%). Ovarian size did not vary significantly between the two groups. Follicle count was increased in women with müllerian duct anomalies. Renal anomalies were present in 16 of 65 patients, five of whom had concomitant ovarian maldescent. CONCLUSION The incidence of ovarian maldescent is increased in patients with müllerian duct anomalies, with the highest association seen in those with didelphys, unicornuate, or bicornuate uterus.
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Raziel A, Friedler S, Gidoni Y, Ben Ami I, Strassburger D, Ron-El R. Surrogate in vitro fertilization outcome in typical and atypical forms of Mayer-Rokitansky-Kuster-Hauser syndrome. Hum Reprod 2011; 27:126-30. [DOI: 10.1093/humrep/der356] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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In vitro fertilization surrogacy in rare coexisting Mayer-Rokitansky-Kuster-Hauser syndrome and triple X karyotype. Fertil Steril 2011; 95:1788.e11-3. [DOI: 10.1016/j.fertnstert.2010.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/30/2010] [Accepted: 11/09/2010] [Indexed: 11/15/2022]
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Laparoscopically-assisted transabdominal oocyte retrieval in an infertility patient with ovarian malposition. Reprod Med Biol 2009; 8:85-87. [PMID: 29699312 DOI: 10.1007/s12522-009-0011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 03/23/2009] [Indexed: 10/20/2022] Open
Abstract
Infertility patients with malpositioned ovaries have considerable difficulty conceiving naturally because of extended fallopian tubes and ovarian malposition; such patients turn for help to assisted reproductive technology (ART) treatment. For most of these patients, ovarian malposition prevents transvaginal oocyte retrieval, so the transabdominal approach for oocyte retrieval is required. One of our infertility patients presented with ovarian malposition, and laparoscopy-assisted transabdominal oocyte retrieval was performed. We performed a Gonadotropin-releasing hormone agonist (GnRH-a) long protocol with human menopausal gonadotropin (hMG) ovarian stimulation, and used a standard transvaginal probe through the anterior abdominal wall for ovarian imaging and monitoring of the growing follicles. The patient underwent laparoscopically-assisted transabdominal oocyte retrieval-9 oocytes were recovered, and 5 were fertilized, and 2 embryos were transferred to the patient's uterus. The patient became pregnant and a gestational sac was detectable by transvaginal ultrasonography, but she spontaneously miscarried. The patient then received several laparoscopically-assisted transabdominal oocyte retrievals and finally became pregnant following a thawed embryo transfer during a hormone replacement cycle, and now her pregnancy is going well.
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Raziel A, Vaknin Z, Schachter M, Strassburger D, Herman A, Ron-El R, Friedler S. Reply of the Authors. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Damario MA. Finding the right stuff--search strategies can and do make a difference! Fertil Steril 2007; 88:251; author reply 251-2. [PMID: 17548087 DOI: 10.1016/j.fertnstert.2007.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Indexed: 10/23/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:289-96. [PMID: 17495648 DOI: 10.1097/gco.0b013e3281fc29db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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