Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome

Fertil Steril. 2010 Feb;93(3):874-9. doi: 10.1016/j.fertnstert.2008.10.028. Epub 2008 Dec 6.


Objective: To report the first case series of ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration (TVOA).

Design: Retrospective analysis.

Setting: In vitro fertilization unit of a tertiary university hospital.

Patient(s): Patients who underwent TVOA during a 6-year period.

Intervention(s): Surgical intervention due to active bleeding from the ovary.

Main outcome measure(s): Prevalence and risk factors.

Result(s): 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.

Conclusion(s): Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.

MeSH terms

  • Acute Disease
  • Adult
  • Biopsy, Fine-Needle / adverse effects
  • Biopsy, Fine-Needle / methods
  • Biopsy, Fine-Needle / statistics & numerical data
  • Body Weight
  • Catastrophic Illness / epidemiology
  • Female
  • Fertilization in Vitro
  • Hemorrhage / epidemiology*
  • Hemorrhage / etiology*
  • Humans
  • Infertility, Female / epidemiology*
  • Infertility, Female / therapy*
  • Oocyte Retrieval / adverse effects*
  • Oocyte Retrieval / methods
  • Oocyte Retrieval / statistics & numerical data
  • Ovary / diagnostic imaging
  • Polycystic Ovary Syndrome / epidemiology*
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Ultrasonography
  • Vagina
  • Young Adult